Treating Substance Use Disorder

In the past, society viewed drug addiction as a moral flaw. Popular "treatments" involved imprisonment, sentencing to asylums, and church-guided prayer. Not surprisingly, these methods did not work.

Today we understand that substance use disorder is a brain disease, and it needs to be treated as a medical condition. Modern treatments are based on scientific research. Treatment is tailored to the individual and typically involves a combination of drug and behavioral therapy. These methods are effective: about 90% of those who enter evidence-based treatment get better.

With some drugs, suddenly stopping use can cause painful withdrawal symptoms. In the past, suffering through withdrawal was considered a necessary part of rehabilitation. It was the punishment for having the moral flaw of addiction.

Today we know better. While stopping use of the drug is a necessary step in recovery, patients should not have to suffer. In fact, allowing painful withdrawal gets in the way of recovery. Patients know that going back to the drug will instantly make their symptoms go away.

To prevent withdrawal symptoms, patients can take medication that has a similar effect to the drug, then gradually decrease the dose over time. Examples of this type of treatment include methadone for opioid treatment, nicotine replacement therapies (patch, gum) and bupropion for nicotine treatment, and benzodiazepine and anti-seizure drugs for barbiturate treatment. These medications stabilize the brain, allowing the patient to focus on other aspects of recovery.

Dr. Adam Gordon at the University of Utah trains medical providers in best practices for treating opioid use disorder. Many patients prefer to receive treatment at their regular doctor’s office. They may already have a trusting relationship with their doctor, or they may want to avoid the stigma associated with treatment centers.

Regardless of where you receive treatment, your privacy will be protected. Dr. Gordon encourages anyone who thinks they may have substance abuse disorder to talk to their doctor.

Some people believe that using medication to treat drug addiction does not lead to recovery because it’s just replacing one drug with another. But this is not the case.

Medications for treating substance use disorder are controversial because they are drugs that often have potent, intoxicating effects. And because patients often require continuous treatment, sometimes over many years.

Yet these medications stop cravings and allow the patient to begin functioning normally again. They prevent relapse and buy crucial time for cognitive and behavioral therapies to begin working.

Maintenance and medication also protect the patient from the dangers that often come with illegal drugs. They don’t have to risk arrest, physical harm, exposure to diseases, or the shame that comes with buying drugs illegally. When you don’t have these problems to worry about, you can focus on other aspects of recovery.

Some people can recover from substance abuse disorder just using medication. But often times successful treatment includes counseling, support groups, and other forms of therapy. Patients may need help learning new ways of thinking and behaving. Many patients also must find new ways to address the problems that led them to abuse substances in the first place—issues like trauma, chronic pain, or mental illness.

Cognitive and behavior therapy can include such things as learning to:

• Talk openly about personal experiences
• Manage problems without turning to drugs
• Identify and correct problem behavior
• Identify and correct harmful patterns of thinking
• Recognize drug cravings
• Identify and manage high-risk situations
• Establish motivation to change
• Improve personal relationships
• Develop refusal skills
• Manage time more efficiently