Addiction and Dependence: A Primer
Addiction and dependence are not the same thing, although these terms are often used interchangeably.
Addiction is characterized by the inability to stop using drugs or alcohol despite the negative consequences it causes in your life, such as problems with finances, relationships and your physical and mental health. Addiction results when the brain makes ironclad connections between pleasure and the substance of abuse. The association becomes so strong, marked by physical changes in the brain’s structures, that willpower and good intentions alone are rarely enough to overcome the addiction.1
Signs and symptoms that you’re addicted to drugs or alcohol include:
- The inability to stop using despite wanting or trying to
- Losing interest in hobbies you once enjoyed
- Withdrawing from friends or family
- Intense cravings
- Taking risks under the influence that you wouldn’t take sober
Dependence is characterized by changes in the structures and functions of the brain that lead to the brain operating more “normally” when drugs are present than when they’re not.
Chronic drug abuse leads to tolerance, which occurs when the brain changes the way it produces and uses chemicals in order to compensate for the presence of drugs or alcohol. Building a tolerance means that it takes higher and higher doses to get the same effects.
Over time, brain function may reach a tipping point where it begins to need the substance of abuse in order to operate normally. Withholding the substance leads to withdrawal symptoms, which can be excruciating and often lead back to using just to make the discomfort stop. Withdrawal symptoms are the main indication that you’ve developed a physical dependence on drugs or alcohol.
Treating Addiction and Dependence
A quality residential treatment program begins with medical detox, which ends the physical dependence on drugs or alcohol by allowing traces of a substance to leave the brain. During medical detox, which is supervised by a team of physicians and mental health professionals, the substance of abuse is withheld. Various medications may be administered as needed to reduce the danger and discomfort associated with withdrawal as well as to shorten the duration of detox.
While medical detox breaks the physical dependence on a substance, detox alone doesn’t address the addiction, which is far more complex and involves a range of underlying issues that must be addressed and missing skills that must be developed. Some of the most common issues that underlie an addiction include:
- Former trauma, such as physical or sexual abuse
- Chronic stress
- Mental illness, such as anxiety or depression
- Post-traumatic stress disorder, or PTSD, which results from being the witness to or victim of a traumatic event
- Poor familial relationships and dysfunction in the household
- A lack of coping skills for stress and other triggers
Choosing a Treatment Program: Residential vs. Outpatient Treatment
The two main types of treatment programs are residential and outpatient. Residential programs require an individual to live at an inpatient facility while receiving treatment. Outpatient treatment enables an individual to live at home during treatment.
The most important consideration for choosing a treatment program is matching the treatment setting to your needs.2 The least restrictive environment that will be safe and effective is the ideal treatment setting for any individual. The most common treatment settings, from least restrictive to most restrictive, are outpatient, intensive outpatient, short-term residential and long-term residential treatment.
Outpatient and Intensive Outpatient Treatment
Outpatient treatment programs typically include one or two hours of treatment once or twice each week, while intensive outpatient treatment programs typically include around three weekly three-hour treatment sessions and feature a higher level of structure and support.
Outpatient and intensive outpatient treatment programs can be as successful as residential programs, as long as the client:
- Is relatively physically and mentally healthy
- Is ready to fight the addiction
- Has intrinsic motivation to change
- Has a strong support system at home and in the community
For those who are likely to find success with an outpatient program, the benefits of such a program may outweigh those of a residential program. These benefits include:
- A higher level of privacy since an extended absence needn’t be explained
- The ability to continue working, attending school or caring for the family while receiving treatment
- The ability to immediately put what you’ve learned into practice in the “real” world
- A lower price tag than a residential program
Long- and Short-Term Residential Treatment
Short-term residential treatment programs last anywhere from 30 days to six months, while long-term residential programs last from six to twelve months. Residential programs are extremely structured and offer a high level of support for those in recovery. A residential program is essential for those who:
- Have a long history of addiction
- Have a severe addiction
- Had little success with previous outpatient treatment programs
- Aren’t intrinsically motivated to change
- Have a co-occurring mental illness
- Have an unstable or dysfunctional living situation at home
- Have little support at home or in the community
For those who need a high level of structure and support during recovery, residential treatment offers a number of benefits over an outpatient program. These benefits include:
- 24-hour supervision and assistance
- The inability to use drugs or alcohol
- A highly structured program to promote healthy habits
- The ability to focus solely on recovery
- Time away from a dysfunctional living situation
- Removal from triggers that can quickly lead to relapse
- A strong sense of community and belonging
- Regular intensive therapy sessions that delve into important issues underlying the addiction
Residential Rehab Programming: Individual, Group and Family Therapy
The issues that underlie an addiction are addressed in treatment through a variety of traditional and complementary therapies. Therapy takes place in individual, group and family settings.
Individual therapy occurs between an individual and a therapist. The client and therapist will ideally develop a strong relationship based on trust and respect.
Group therapy takes place in a group setting, which can include as few as three members or as many as 12 or more. Group therapy provides a high level of peer support and promotes the sharing of experiences, which helps to boost self-confidence and improve self-esteem.
Family therapy engages family members in treatment and addresses issues of dysfunctional relationships to improve family dynamics and promote a healthier living environment.
Traditional Therapies Used in Residential Treatment
A high-quality treatment program will offer a variety of research-based therapies that are clinically proven to be effective for treating addiction.
A cornerstone of addiction treatment, cognitive behavioral therapy, or CBT, helps individuals learn to evaluate their attitudes, thoughts and behaviors and identify those that are self-destructive. They learn to replace unhealthy ways of thinking and behaving with healthier thoughts and behaviors. During CBT, clients also work on developing coping skills and strategies to help reduce stress and successfully cope with other triggers. According to the National Institute on Drug Abuse’s Principles of Effective Treatment, CBT is the most commonly used and successful therapy for addiction treatment.3
Another cornerstone of successful treatment is family therapy, which helps family members identify and address dysfunction in the family system to improve relationships, rebuild trust and restore function to the household. According to the National Council on Alcoholism and Drug Dependence, addiction is a “family disease” that indelibly affects each family member and leads to unhealthy behaviors, troubled relationships and poor family functioning.4 These issues must be addressed for the best chances of successful long-term recovery.
Motivational Enhancement Therapy
Motivational enhancement therapy, or MET, helps those who are ambivalent toward recovery identify intrinsic motivation to change. MET is led by a trained therapist who leads the client to make self-motivational statements and helps design a concrete plan for change. MET is a proven way to help individuals develop the motivation they need to stop using, and it increases engagement in treatment.
12-Step Facilitation Therapy
Operating under the belief that addiction is a chronic disease that has underlying biological, spiritual and psychological causes, 12-step facilitation therapy addresses each of these aspects as individuals progress through the 12 steps. 12-step programs are a mainstay of residential treatment. One study found that people who participate in a 12-step program like Alcoholics Anonymous or Narcotics Anonymous are six times more likely than those who don’t to still be abstinent a year after treatment ends.5
Relapse Prevention Therapy
Relapse prevention therapy educates individuals about the mechanics of relapse and its three stages. They learn to identify the early signs of relapse, and they become familiar with the signs associated with each stage. They develop an arsenal of skills and strategies to help them cope with stress and other important triggers that can quickly lead to relapse.
Moral Reconation Therapy
For those with a low level of moral reasoning, moral reconation therapy leads to the development of higher-level reasoning skills that take personal and societal well-being into consideration when making a decision. Participants learn to be honest with others and with themselves, develop a positive self-identity, identify a higher purpose in life and create personal goals to work on in treatment.
Dialectical Behavior Therapy
Dialectical behavior therapy, or DBT, helps clients who suffer from borderline personality disorder, suicidal thoughts and self-harm to develop the skills they need to accept and validate their thoughts, feelings and behaviors rather than struggle with them. Through mindfulness and relaxation, participants learn to resist self-destructive urges, make better choices and cope with potent triggers for relapse.
Complementary Therapies Used in Residential Treatment
Complementary therapies are those which lie outside the mainstream but which have been proven effective on a number of levels for treating addiction. A variety of complementary therapies are used in residential treatment programs to enhance treatment, promote physical and mental well-being and increase engagement in treatment.
Art and Music Therapy
Art therapy and music therapy are examples of experiential therapies, which are hands-on treatment modalities that help individuals work through the obstacles in their path to recovery in a deeply personal and meaningful way. Both art therapy and music therapy have been found to help participants creatively express themselves in non-verbal ways to help them tell their story, decrease denial, reduce ambivalence toward recovery and improve motivation for change.6 Other experiential therapies proven effective for addiction treatment include aqua therapy, drum therapy and equine therapy.
Yoga promotes physical and mental balance, flexibility and strength for a higher sense of well-being and better overall health. According to Harvard Medical School, yoga is highly effective for reducing stress, a major relapse trigger, and it helps your body learn to respond to stress in healthier ways.7 Yoga also promotes other healthy lifestyle choices, and it can lead to a stronger self-concept and higher self-esteem.
Meditation is fast becoming a mainstream therapy that helps to treat a wide range of illnesses. Meditation is a potent stress reducer, and it leads to a greater sense of self. Meditation helps individuals identify and replace unhealthy thought and behavior patterns by increasing familiarity with thought processes and promoting self-understanding.8
Massage therapy dramatically reduces stress levels and eases feelings of anxiety and depression to produce a sense of well-being. It also promotes body awareness and helps move toxins out of the body for better overall health.
A 3,000-year-old Chinese technique that involves inserting long, thin needles through the skin, acupuncture stimulates strategic points on the body to relieve symptoms associated with stress, insomnia, anxiety and depression. According to the University of California, acupuncture helps to restore optimal functioning to the body’s systems for a stronger sense of well-being and better overall health.9
Special Considerations in Treatment: Mental Illness and Trauma
A standard residential treatment program may not be adequate for those who suffer from a serious mental illness or who have a history of trauma that has contributed to the addiction.
When someone with an addiction also has a mental illness, it’s known as a co-occurring disorder or dual diagnosis. Treating just the addiction but not the mental illness—or vice versa—likely won’t lead to long-term recovery. For the best possible chance of success, both the addiction and the mental illness need to be treated in tandem, each in the context of the other. Treatment programs that specialize in dual diagnosis offer integrated treatment for both disorders for a better treatment outcome.
Exposure to trauma is strongly linked to substance abuse. The Substance Abuse and Mental Health Services Administration stresses that a trauma-informed approach to care is crucial for those with a history of trauma or who are suffering from post-traumatic stress disorder.10
- Addresses the dire impact of trauma on an individual’s life and ensures a trauma-informed approach to recovery
- Recognizes the signs and symptoms of trauma and how it affects all aspects of an individual’s life
- Integrates information about trauma into best practices, policies and the overall approach to treatment
- Actively seeks to prevent re-traumatization
What Happens When Treatment Ends?
Once the treatment program is successfully completed, an aftercare plan is developed and set in place to help you re-integrate into the community. Aftercare plans are a critical part of treatment and include a number of components that are based on individual need. Highly personalized aftercare plans may include:
- Ongoing individual, group and family therapy
- Participation in a 12-step program
- Relapse prevention programming
- Vocational rehabilitation
- Educational or legal assistance
- Time spent in a sober living facility to help ease the transition back to “real” life
- Ongoing care for any physical or mental illnesses
The aftercare plan helps prevent relapse by ensuring ongoing support in the family and the community, continuing to address your unique needs and challenges. The more engaged you are with the aftercare plan, the better your chances of achieving successful long-term recovery.
What to Look for in a Residential Treatment Program
Unfortunately, not all treatment programs are of high quality. A high-quality program that takes a holistic approach to treatment will help ensure successful recovery. Here are some important factors to consider when looking for a residential treatment program.
Family involvement in treatment has been shown to improve recovery outcomes. Choose a treatment program that includes family members in its treatment protocol. This may include family therapy, family workshops or family support groups.
Research-Based Therapies and Best-Practices Protocol
A quality treatment program will offer research-based therapies and follow the best-practices protocol established by the leaders of the industry. Avoid treatment programs that utilize controversial, potentially dangerous or emotionally harmful tactics.
A Holistic Approach
A holistic approach addresses the whole person—body, mind and spirit. It will offer traditional therapies along with complementary therapies like meditation and art therapy to ensure a well-rounded approach that meets multiple needs.
Individualized Treatment Plan
There is no single path to addiction recovery. A high-quality residential treatment program will work with you to develop a highly individualized plan for treatment and recovery. The plan will be continually assessed for relevance as your needs change and new ones emerge.
A high-quality treatment program will be able to back up their success claims with evidence. They will have a mission statement, and their operation will embrace transparency.
Choose a program that’s accredited by the state and that employs trained, licensed therapists.
Look for a residential facility that feels homey rather than institutional. Environment can impact healing, and a high-quality center will strive for aesthetically pleasing decor and a warm, inclusive atmosphere.
If you have dietary restrictions or a disability, find a program that will accommodate your needs. If you have a co-occurring mental illness, look for a program that specializes in dual diagnosis. If you prefer a gender-specific program or one which caters to a particular demographic, look for a treatment facility that offers the kind of programming and support you need.
Treatment helps you change from the inside out. It helps you evaluate the way you think and behave and make changes where your thoughts and beliefs lead to self-destructive behaviors. It helps you develop the coping skills you need to handle stress and other triggers, and it leads you to identify a higher purpose in life. In treatment, you’ll learn to enjoy yourself again without drugs or alcohol, and you’ll learn how to develop healthy, fulfilling friendships and work on healing existing dysfunctional relationships.
Through a holistic approach to residential treatment, you’ll emerge on the other side a happier, healthier person with a higher sense of well-being and better quality of life.
- DrugFacts: Understanding Drug Use and Addiction. (2016, August). Retrieved from https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction
- Treatment Improvement Protocols: Specialized Substance Abuse Treatment Programs. (1997). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64815/
- Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). (2012, December). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
- Family Disease. (2016, February 24). Retrieved from https://www.ncadd.org/family-friends/there-is-help/family-disease
- Laudet, A. B. (2008) The Impact of Alcoholics Anonymous on Other Substance Abuse Related Twelve Step Programs. [I Recent Developments in Alcoholism, 18, 71-89. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613294/
- Aletraris, L., Paino, M., Edmond, M. B., Roman, P. M., & Bride, B. E. (2014). The Use of Art and Music Therapy in Substance Abuse Treatment Programs. [I Journal of Addictions Nursing, 25(4), 190-196. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268880/
- Yoga for Anxiety and Depression. (2009, April). Retrieved from http://www.health.harvard.edu/mind-and-mood/yoga-for-anxiety-and-depression
- Corliss, J. (2014, January 8). Mindfulness Meditation May Easy Anxiety, Mental Stress. Retrieved from http://www.health.harvard.edu/blog/mindfulness-meditation-may-ease-anxiety-mental-stress-201401086967
- How Acupuncture Can Relieve Pain and Improve Sleep, Digestion and Emotional Well-Being. (n.d.). Retrieved from http://cim.ucsd.edu/clinical-care/acupuncture.shtml
- Trauma-Informed Approach and Trauma-Specific Interventions. (2015, August 14). Retrieved from http://www.samhsa.gov/nctic/trauma-interventions