What is Substance Abuse and How Do I Find Treatment?

What is Substance Abuse?

Most people have tried drugs. Some have tried them once. Others continue to use them recreationally with little consequences. And still many find themselves abusing drugs with harsh consequences in many facets of their life.

There is a difference between substance use and substance abuse. There is no generalized, concrete way of distinguishing the two; however, abuse typically implies that the person’s behavior is leading to negative consequences in their life.

This page will set out to define substance abuse and discuss options for treatment. It will include information on:

• Definitions of substance abuse.
• Substance use disorders (i.e., SUDs or “addictions”).
• Different avenues of treatment (e.g., inpatient vs. outpatient).
• Types of treatment (e.g., cognitive-behavioral therapy, family therapy).
• How to find treatment.
• Specific questions to ask treatment centers, designed to help you find the most qualified center and maximize your likelihood of success in treatment.

Definitions of Substance Abuse

Substance abuse is the harmful or hazardous use of chemical substances. These substances, typically alcohol or illicit drugs, have psychoactive effects and lead to alterations in physiology, cognition, and behavior.

Repeated use of substances can lead to dependence and negatively impact one’s health and level of functioning across a variety of domains, including:

• Physical health (e.g., cardiovascular problems, respiratory issues, liver damage).
• Psychological health (e.g., anxiety, depression, psychosis).
• Neuropsychological functioning (e.g., impaired concentration and memory).
• Relationships.
• Work.

Substance abuse is often synonymous with the word “addiction.” While “addiction” refers to both substances and behaviors (e.g., eating, gambling, and sex), more broadly, “substance abuse” refers to the use of psychoactive substances, specifically. Definitions of addiction, however, can help us more clearly understand substance abuse.

Here is one definition of addiction:

“Repeated involvement…despite excessive costs, because of craving.” [1]

Notice the two central concepts: excessive and craving. Substance use can turn into an addiction when it is done in excess and involves craving. When substance use turns into an addiction, the medical community refers to this as a “substance use disorder (SUD).”

SUDs, among other variables, are characterized by continued use despite negative consequences in one’s life. Therefore, this leads us to the following definition of substance abuse or substance addiction:

“Substance abuse is the repeated and excessive use of drugs, due to craving, despite the presence of negative consequences in one’s life.”

Substance Use Disorders (SUDs)

When you use use substances in excess, develop a craving or dependence on them, and continue to use despite negative consequences, you might have a substance use disorder (SUD). Remember that SUDs, just like other psychological disorders (e.g., anxiety, depression), is only a label; it does not define a person, account for all of their complexities (including their multitude of positive attributes), and should be used, if at all, in the manner that the affected individual prefers.

You should always consult a medical professional before attempting a “self-diagnosis.” The following criteria, however, are meant to give you an idea of what a SUD entails [2].

• Using the substance in larger amounts or over a longer period than was originally intended.
• The individual expresses a persistent desire to cut down or stop using the substance, but efforts have been unsuccessful.
• The individual spends a great deal of time obtaining the substance, using it, or recovering from it.
• Craving: An intense desire or urge for the drug that may occur at any time.
• Impairment in the ability to fulfill responsibilities at work, school, home, or other social domains.
• The individual continues to use the substance despite significant social or interpersonal problems.
• Social, occupational, or recreational activities that were once enjoyed are given up because of substance abuse.
• The substance is used in a way that is physically hazardous (e.g., dirty needles).
• The individual continues to use the substance despite knowledge of adverse physical or psychological consequences.
• Tolerance: The individual needs more and more of the substance to achieve the desired effect.
• Withdrawal: The individual experiences adverse physiological or psychological effects when stopping the drug, which often leads to reusing the substance to prevent such effects.

Typically, a SUD is given when at least 2 of the above criteria are met within a 12-month period and the individual experiences significant impairment and distress related to their use.

Substance Abuse Treatment Programs

Treatment for substance abuse can take many forms. On the broadest level, there are inpatient programs and outpatient programs. Within these 2 categories, there are various types of therapeutic approaches.

Inpatient Programs

Inpatient rehab facilities typically last 30-90 days. Individuals live at the facility, which can have both costs and benefits: on the one hand, you may have to leave behind work, family, and other obligations; on the other hand, you can focus on your recovery and receive 24-7 monitoring and care.

Inpatient programs typically offer the following services:

• Detox: Stopping drug use can lead to severe withdrawal symptoms. Proper detoxification involves medical supervision and treatment.
• Medication and medical supervision: Most inpatient programs have medical professionals that prescribe drugs, if necessary, for SUDs or co-occurring psychological disorders.
• Individual counseling: Drug counseling and psychotherapy are indispensable to successful treatment. Most of the time, psychiatric conditions like anxiety, depression, and trauma accompany drug use. It is important to address both substance and psychiatric disorders during treatment.
• Group therapy: Group sessions are designed to facilitate discussion and support amongst individuals struggling with similar experiences. Group support may come in the form of a 12-step/spiritual orientation, a secular addiction approach (e.g., SMART Recovery), or another form of group therapy.
• Alternative amenities: Some facilities offer amenities like yoga, acupuncture, spa treatment, access to nature, or specialized nutrition programs. These facilities are costlier but many seek out and prefer these types of services.

Outpatient Programs

Outpatient substance abuse programs allow individuals to live at home and commute to the facility. The amount and frequency of treatment sessions varies; some programs have day-long sessions multiple times a week, and others last one hour and are held once per week or less.

Outpatient programs offer similar services as inpatient, including individual and group counseling, but are less structured and have less oversight. Outpatient programs are generally better suited for:

• Individuals who have a less severe substance abuse problem.
• Individuals who have recently completed an inpatient rehab program and are looking for continued care and support.
• Those who have less financial resources or who cannot take time away from work or family.

Find a Rehab Facility or Program

There are various rehab programs to choose from. You want to make sure you choose the one that is best suited to your needs and will give you the best chance for recovery.

You might also seek out support groups like alcoholics anonymous (AA), narcotics anonymous (NA), SMART recovery, Women for Sobriety, Rational Recovery, or LifeRing.

What Should I Look for in a Rehab Treatment Center?

There are a number of treatment centers out there, and they often come with big promises. It is your responsibility to be an informed consumer and learn about each program you are considering.

The following is a list of questions you should ask each center, based on the most important predictors of treatment success [3].

You might also want to send a detailed letter to each treatment center with these questions.

• Therapeutic alliance:
  • How does your staff develop and monitor a therapeutic alliance with clients?
  • How do they handle impasses or strains over the course of treatment?
  • Staff continuity of care is important. Please share your staff turnover data. What have you done to address this?
• Engagement in treatment:
  • What engagement strategies does your treatment center employ? Are staff trained in using Motivational Interviewing?
  • How do staff engage clients in goal setting and developing a long-term recovery plan?
  • What is the weekly treatment schedule? Can I have a copy? Please indicate which of these have empirical support, and which are effective for comorbid disorders.
  • How does your staff integrate treatment for dual-diagnoses?
  • What specific coping skills do you teach?
• Treatment strategies:
  • How effective has your treatment program been in helping clients become abstinent, or reducing substance use, and living a healthy life? Please share any long-term outcome data that you have.
  • How does your staff adapt its treatment program to the individual and his/her ongoing progress (or lack thereof)?
• Planning life after rehab:
  • How does your center conduct an assertive after-care plan?
  • What, specifically, do you do in the form of contracts, self-assessments, and ongoing follow-up?
  • Describe clearly how patients, while in the facility, plan for their life after discharge? Are others (family, sponsors, etc.) involved in this plan?

Treatment Modalities for Substance Abuse

Whether you choose an inpatient or outpatient facility, a variety of treatment modalities might be used during therapy. The most common treatment approaches include:

• Cognitive behavioral therapy (CBT).
• Dialectical behavior therapy (DBT).
• Mindfulness-based interventions.
• Motivational interviewing (MI).
• Contingency management (CM).
• 12-step approaches.
• Family therapy techniques like CRAFT.

References

1. Horvath, A. T. (2004). Sex, drugs, gambling, and chocolate: a workbook for overcoming addictions, second edition. Atascadero, CA: Impact Publishers.
2. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-V). Arlington, VA: American Psychiatric Association.
3. Meichenbaum, D. (2016, February). Treatment of clients with substance abuse and co-occurring disorders. Presented at 37th Annual Training Institute on Behavioral Health and Addictive Disorders, Clearwater Beach, FL.

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