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Treatments for drug and alcohol abuse

Drug dependence is treatable. With the help of treatments targeting individual needs and concerns, people can control their drug taking behaviour and live happy and successful lives.

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What is drug dependence?

Drug dependence is a pattern of repeated drug taking that usually results in:

  • tolerance – the need for greater amounts of the drug to achieve the same effect
  • withdrawal – physical and cognitive effects when drug use declines or stops
  • compulsive drug taking behaviour – drug taking that persists despite efforts to reduce intake and despite problems with family, friends, and work.

Drug dependence is a complex problem. It encompasses a diverse range of drugs (such as alcohol, cannabis, amphetamines, and cocaine) and is caused by many different factors.

Problems with drugs are frequently accompanied by other psychological problems, such as behavioural disorders, depression, anxiety, and eating disorders.

These co-occurring psychological problems must be addressed when seeking treatment for drug dependence, as they may interfere with the effectiveness of treatment.

Treatment options

There are several treatment options available for drug dependence. These differ in their aims and outcomes. Elements of these treatment options are often combined.

Self-help

Self-help options vary but most involve the individual being responsible for their own treatment. Books, videos, telephone and online support are some of the self-help options available. Typically, self-help materials involve some form of assessment of drug taking behaviour and associated consequences.

It also involves monitoring the drug taking behaviour (including the conditions in which the drug is taken and the physical, emotional, and behavioural consequences of taking the drug), education about drugs and their effects, modification of drug taking behaviour, and access to support.

Self-help components are commonly incorporated into other forms of treatment. Self-help groups are managed and run by people with drug issues. Because the members have drug issues, these groups can offer great insight, understanding, and support. An example of a self-help group is Narcotics Anonymous or Alcoholics Anonymous.

Counselling

There are many different types of counselling techniques. Although they each have different theories and methods, they often address common issues.

  • Motivational interviewing – techniques concentrate on increasing motivation to change among individuals who have not yet made a decision to change or are not sure that they can change. It aims to make the client accept responsibility for their problems and the consequences of those problems, and tries to help the client commit to particular treatment goals and strategies. The technique is relatively time-limited and often incorporates feedback, advice, and empathy.
  • Family therapy – involves all family members in the treatment process. This is because drug problems are thought to be related to dysfunctional family relationships and interactions. Family therapies often involve other people in the person’s social network, such as teachers and friends, who may affect the person’s drug use. The goals of family therapies are to improve family communication, provide education about drugs and their consequences, enhance problem solving, identify parental substance abuse problems, and improve family relationships.
  • Rational emotive therapy and cognitive behavioural therapy – these aim to challenge and change the irrational and negative thoughts (cognitions) that are thought to be responsible for drug taking and to change and reduce drug taking behaviours. Read more about this type of therapy here.
  • Skills training – based on the belief that substance dependence represents a means of coping with difficult issues and stress. The training of skills is thought to provide more functional and healthier options for coping with stress. A variety of life skills are developed, including social skills, assertiveness, drug refusal skills, problem solving skills, relaxation, and managing crises. Training involves presenting the rationale for learning the skills, modeling, practicing, and feedback.
  • Relapse prevention – involves the development of strategies to help maintain drug abstinence. Various techniques are used to prevent ‘relapse’ or the re-initiation of drug use. These techniques include the identification of high-risk situations for relapse, instruction and rehearsal of strategies for coping with those situations, self-monitoring, strategies for recognising and coping with cravings and thoughts about the drug, planning for emergencies, and coping with lapses and relapses. Training involves rehearsing skills, role-playing, and homework tasks.
  • Pharmacotherapy (or drug therapies) – can be used in a number of ways to treat drug dependence. Drugs are sometimes used for suppressing withdrawal symptoms and drug cravings, stabilizing symptoms, and blocking the effects of specific drugs. Pharmacotherapies are most commonly used for the treatment of coexisting psychological problems, such as depression and anxiety. The types of drugs used to treat coexisting psychological issues need to be selected carefully, as they may be addictive and can affect recovery. Pharmacotherapies are often combined with counselling. Combining drug therapies with counselling has been found to improve a broader range of problems, increase adherence to treatment, and helps to overcome many of the problems that some approaches can have.

Factors affecting treatment

  • Treatment settings – treatment can occur either in in-patient settings, such as hospitals and residential units, or in out-patient settings. Where treatment takes place depends on a number of factors, such as the presence of psychiatric problems, family and social supports, the severity of the problem, and previous treatment efforts.
  • Treatment goals – there are two major types of treatment goals – abstinence and reduction. Abstinence involves never taking the drug again, whereas reduction (or harm minimization) involves reducing the amount of the drug taken to a relatively safe level. Each approach differs according to difficulty level and types of outcomes. Which goal is chosen depends on the type of treatment option, whether you think you’ll be able to stick with your goal, the outcome you would prefer, and how much support you have.

Which treatment option should I choose?

It’s important to realise not all treatments are suitable for everyone. The treatment option that’s best for you depends on how long you’ve had the drug problem, the severity of the problem, and the type of drug used. For drug dependence problems, it’s recommended you seek the help and support of a mental health professional. Contact the HSE for information on their Drugs and Alcohol Counselling and Information Service.

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This article was last reviewed on 24 March 2017

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