Introduction
Addiction is a worldwide problem that affects many different people, their families, and communities. In 2014, about 435,000 Americans ages 12 or older reported currently using heroin, and 4.3 million reported nonmedical use of prescription opioids. Addiction is a chronic disease, like diabetes or heart disease, meaning there is no cure. But addiction can be managed, and people with addiction can, and do, recover.
Treatment using safe and helpful methods provided by trained clinicians can lead to a healthy, positive way of life. This healthy way of life is referred to as recovery. Treatment with a medication along with counseling and other support is often the most effective choice for opioid addiction and part of recovery.
This document provides facts about treatment from The American Society of Addiction Medicine (ASAM) – the leading medical society for addiction treatment. Learn more about ASAM at www.ASAM.org.
Definition of Addiction*
Addiction is a chronic brain disease in which a person regularly finds and uses drugs, or regularly does something (such as gambling) despite the negative things that can happen. It is a brain disease because addiction can change how the brain works. Besides harming a person’s health, it can change how someone thinks and feels. This may last a long time, lead to other harmful actions, and cause difficult relationships with family and friends. Without treatment and recovery, addiction may keep getting worse.
*Modified from ASAM Definition of Addiction
Assessment
Seeking help is the first important step to recovery. The next step in the process is to meet with a qualified clinician. A clinician is a health professional, such as a physician, psychiatrist, psychologist, or nurse. The clinician will review or assess how someone is doing - this first meeting is called an assessment. The goal of the assessment is to gain a thorough understanding of the patient. This will help the clinician and patient develop a treatment plan that best matches the patient’s needs.
Getting Started
- The clinician will ask questions to understand nearly every part of a patient’s life. The more that is known, the better treatment can be planned with the patient.
- Common assessment questions include:
- How long has someone been using drugs?
- What other medications are being taken?
- Are there special social or financial circumstances, or needs?
- Is there a family history of addiction?
- Are there other mental or chronic health problems?
- Common assessment questions include:
- The next step is a complete physical examination to check the patient’s overall health. This includes finding other common conditions (physical or mental) related to addiction which may change how a patient is treated.
- The physical examination will include tests to find both health problems and drugs in someone’s body. The most common drug test uses a patient’s urine and is called urine analysis.
Treatment Overview
After the assessment, the clinician will discuss all recommended treatment options with the patient. Every patient situation is different, so choosing the best options is a shared decision between the patient and the clinician.
There are three main choices for medication to treat opioid addiction: methadone, buprenorphine and naltrexone. These medications are used along with counseling and other support.
Treatment can occur in several different places or settings depending on the medication used, the patient’s situation and other factors. Four broad treatment settings should be considered: ASAM Level 1 (outpatient), ASAM Level 2 (intensive outpatient or partial hospitalization), and ASAM Levels 3 and 4 (residential addiction treatment or hospital settings). It’s important to discuss the many different treatment settings with the clinician to determine which is most appropriate.
Treatment Plan
- After discussing the assessment and treatment choices with the clinician, including the ASAM Level of Care, it’s time to finish the treatment plan.
- It is common for both the patient and clinician to sign an agreement about what to expect during treatment. This can include: treatment goals, which medications are used, treatment schedule, and counseling plan.
- The treatment plan will also include:
- Regular visits to the treatment center/clinician
- Medications: usually methadone,
buprenorphine or naltrexone - Patient commitment to cooperate with treatment
- Risks of relapse and other safety concerns.
Patient Participation
- At the same time, a patient should expect to be treated with respect and dignity and have concerns listened to when starting or changing the treatment plan.
- To avoid health problems, patients must share with clinicians any other medications they are taking or if they drink alcohol regularly. This is very important – certain medications and regular alcohol use can cause major problems with certain treatment medications.
- Common patient responsibilities include:
- Keeping all appointments
- Agreeing to drug testing on a regular basis
- Taking medications as prescribed
- Only using drugs that are prescribed
- Allowing and encouraging involvement of family and friends
- Avoiding persons, places and situations that may cause a person to use a substance again after a period of not using—also known as relapse.
Counseling
- Counseling is an important part of treatment and is usually required with all medications.
- Counseling should be done with a qualified clinician or health professional – this person will play an important role with the care team. Counseling may be done in the same place the medication is given, or by another clinician outside the treatment setting.
- Counseling helps patients address personal, social or
other problems that may contribute to their addiction. Examples can be:- Improving feelings of self-worth
- Difficult situations at work or home
- Spending time with people who use drugs or alcohol
- In addition to counseling, patients are also encouraged to join support groups that include other patients who are also in recovery.
- Counseling is not limited to the patient - there are also many support groups for family and friends of those dealing with addiction. Remember, addiction affects friends and family as well.
Support from Family and Friends
- Families and friends play a key role, and should try to learn as much as possible about addiction to improve the chances of a long-lasting recovery.
- Places, persons and events associated with addiction may contribute to a relapse. It is very important that a patient avoids persons, places and other reminders of his/her drug use or learn how to respond to those reminders in ways that do not involve alcohol or drug use. This requires the continued support and encouragement of friends and family who are outside of that environment.