The UK has been repeatedly named the addiction capital of Europe. Statistics show that at least 589,000 people in England depend on alcohol, and at least a quarter of these people are receiving help for mental health.
There are severe consequences of addiction, both for the individual and society, which is why there is a great need for effective and accessible addiction treatment. With the development of our understanding of addiction as a treatable condition, many psychologically informed treatment approaches have been developed.
Addiction has a significant impact on a person's life, freepik.com
- We will start by defining addiction treatment meaning.
- Next, we will discuss detoxification as the first step to recovering from substance use.
- Finally, we will discuss the mechanisms of change behind common treatment interventions, including aversion therapy, self-management programmes, cognitive Behavioural Therapy and group therapy.
Addiction Treatment meaning
Addiction is a treatable medical condition that causes significant impairment in one's functioning. The 11th edition of the International Classification of Diseases (ICD-11) recognises behavioural addictions (compulsive gaming or gambling) and addictions to substances, all of which can be treated. Addiction treatments aim to support clients in the process of recovery and prevent future relapses.
Addiction is a chronic medical condition involving compulsive use of substances or an inability to control an impulse to engage in rewarding activities, despite associated risks or negative long-term consequences.
Individuals struggling with addiction may be offered different treatment options depending on what they are addicted to or the stage of recovery that they are in.
For many people with substance addiction, detoxification is the first step. At later stages of recovery, pharmacological treatments with therapeutic interventions and participation in self-management programmes can help prevent relapse.
A combination of different treatments is considered the most effective as it holistically addresses different factors contributing to addiction.
Detoxification
One of the key features of substance addiction is dependency. Dependency develops when a person becomes unable to function without the substance they are addicted to. Physical dependency causes withdrawal symptoms when a person attempts to stop or reduce substance intake, making it a major obstacle to recovery.
Detoxification involves going through withdrawal symptoms after discontinuing substance use.
The withdrawal symptoms experienced during alcohol detoxification may involve psychological symptoms like anxiety, depression, irritability, or even hallucinations, as well as physical symptoms like insomnia, nausea, vomiting, loss of appetite, headaches, hand tremors and elevated heart rate.
Getting through withdrawal is often considered to be the first step to recovery. Depending on the severity of use, detoxification can be attempted at home or a detoxification facility. The withdrawal symptoms are monitored by medical staff, and medication can be administered to reduce the discomfort.
One of the things that makes opioids highly addictive is how quickly they lead to physical dependency. Repeated opioid use diminishes the brain's natural ability to regulate physical and emotional pain. The tolerance to opioids builds quickly, meaning the user has to increase opioid intake to achieve the same pleasurable effects. Any attempt to reduce or discontinue opioid use can result in serious withdrawal symptoms, making it very hard for users to quit and recover.
However, detoxification alone may not be sufficient for helping people achieve long-term recovery. Even after detox programmes, it is common for people to experience cravings or become triggered and start using again. It is estimated that over 50% of people will relapse after undergoing detoxification in a special facility (Deng et al., 2022). To help people maintain long-term recovery, other interventions that focused on relapse prevention are often necessary.
Patients often go to rehabilitation centres to recover from addictions, freepik.com/pch.vector
Aversion therapy
Aversion therapy is a behavioural intervention, which relies on the principles of classical conditioning, and was first developed to treat alcoholism in the 1930s. During aversion therapy, a behaviour or substance is paired with a real or imagined aversive stimulus, creating a negative association with the subject of addiction.
Aversion therapy assumes that people use intoxicants or engage in compulsive behaviours because they associate them with rewarding effects. By changing the associations with the behaviours or substances they are addicted to, aversion therapy attempts to condition people to avoid them in the future.
The techniques used in aversion therapy included pairing images of drinking with the administration of weak electric shocks, or serving alcoholic drinks to people right after giving them medication that induces side effects such as vomiting. However, nowadays, aversive therapy relies more on imagined aversive stimuli than invasive techniques like electroshocks.
Medication is often used in aversion therapy to induce adverse side effects such as headaches or vomiting, freepik.com/storyset
Evaluation of aversion therapy for addiction treatment
Aversion therapy can be criticised for reducing a complex problem of addiction to positive associations and not considering potential underlying issues that led one to the addiction in the first place. Addiction can be a result of an attempt to self-medicate or a way for people to cope with the stresses of life. Creating an aversion to the substance doesn't solve any underlying problems.
There are also several ethical concerns related to traditional aversion therapy techniques, as they involve physical and psychological harm. Also, due to its unpleasant nature, the number of people that would opt for this treatment and remain compliant for its duration could be limited. Finally, although aversion therapy has been used for almost a century, there is no strong evidence for its efficacy. Moreover, high relapse rates following this treatment question the long-term effectiveness of this intervention.
Pharmacological interventions in addiction treatment are sometimes considered to be a form of aversion therapy, although they can be better understood as discouragements of use, helping people avoid relapse. Pharmacological interventions have shown great long-term efficacy in addiction treatment, especially in combination with psychological interventions.
Disulfiram is a medication that can be used to help people maintain abstinence from alcohol. When alcohol is consumed with disulfiram, it causes unpleasant physical effects, deterring people from drinking even small amounts of alcohol. Another drug used in recovery from alcoholism is naltrexone. Naltrexone can help reduce cravings as well as the pleasant effects of consuming alcohol.
Self-management programmes
Self-management programmes offer treatment for both substance and behavioural addictions. Common self-management programmes include 12-step programmes like Alcoholics Anonymous or Narcotics Anonymous. While traditionally, 12-step programmes are faith-based, there are also self-management programmes available without the spirituality component.
Self-management programmes view their participants as active agents, capable of being responsible for their recovery. Other key features of self-management programmes include social support from other people that are also in the process of recovery, and providing members with a safe, non-judgemental space to reflect on and share their experiences. These elements make self-help groups potentially beneficial for people's mental health and relapse prevention.
The success of self-management programmes largely depends on one's motivation and readiness to change. Generally, evidence shows self-management programmes to be effective (Vederhus & Kristensen, 2006). However, this remains to be an under-researched intervention.
Cognitive Behavioral Therapy
Cognitive Behavioural Therapy (CBT) aims to help people recognise connections between their thoughts, feelings, and behaviours. It attempts to reduce people's need to engage in compulsive behaviours by challenging irrational or maladaptive thoughts perpetuating their addiction. CBT for addiction also involves identifying addiction triggers and expanding clients' repertoire of adaptive coping skills to avoid relapse. While the goal of detoxification and self-management programmes is abstinence, it doesn't necessarily have to be the goal of CBT, making it a more flexible intervention.
During CBT, negative thinking and beliefs are challenged. For example, if a client holds a strong belief that they cannot socialise without drinking, they will be encouraged to challenge this belief by meeting with a friend while sober. Suppose a client has a strong belief that they are a failure, which drives their addiction. In that case, a therapist might challenge this belief with techniques like Socratic questioning or by conducting an evidence/counterevidence analysis.
Meta-analyses support the effectiveness of CBT as an intervention for treating addictions (Magill & Ray, 2009). However, the effects of CBT appear to diminish with time.
Group Therapy
Group therapy for addiction combines peer support with evidence-based psychological interventions like CBT, skills development, psychoeducation or interpersonal process therapy. Groups consist of multiple members seeking treatment for similar difficulties and a therapist leading the therapy. One advantage of group therapy over individual therapy for addiction is the sense of community it involves, it can also be more cost-effective for services.
There is some empirical support for the effectiveness of group therapy in addiction treatment. However, since many factors contribute to addiction, it is typically best to offer people a combination of treatments.
A review of studies investigating the efficacy of group therapy in substance use treatment has found it to be effective in the treatment of cocaine addiction, marijuana addiction and mixed substance use disorder (López et al., 2021). Moreover, group therapy in combination with pharmacological treatment was shown to be more effective in treating opioid addiction than pharmacological treatment alone.
Addiction Treatment - Key takeaways
- Addiction treatment aims to support clients in the process of recovery and prevent future relapses. Holistic addiction treatment requires a combination of interventions.
- Aversion therapy is a behavioural intervention that relies on classical conditioning principles. A behaviour or substance is paired with real or imagined aversive stimuli, creating a negative association with the subject of addiction.
- Self-management programmes encourage their members to take accountability for their recovery, they also involve peer support and provide a safe, non-judgemental space for members to reflect on and share their experiences.
- Cognitive Behavioural Therapy targets irrational or maladaptive thoughts that perpetuate addiction. During CBT, clients also identify addiction triggers and can expand their repertoire of adaptive coping skills to avoid relapse.
- Group therapy for addiction combines peer support with evidence-based psychological interventions.
References
- Gov.UK. (2020). Alcohol dependence and mental health.
- Deng, R., Yang, X...Guo, W. (2022). Data-driven study on resting-state functional magnetic resonance imaging during early abstinence of alcohol dependence in male patients and its predictive value for relapse. BMC Psychiatry.
- Vederhus, J., & Kristensen, O. (2006). High effectiveness of self-help programs after drug addiction therapy. BMC Psychiatry.
- Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug users: Analysis of randomized controlled trials. Journal of Studies on Alcohol and Drugs.
- López, G., Orchowski, L. M... Johnson, J. E. (2021). A review of research-supported group treatments for drug use disorders. Substance Abuse Treatment, Prevention, and Policy.
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