Substance Use Treatment

Substance Use Treatment

Part One: Recovering from a substance use addiction

If you, or someone you know, are considering a treatment for a substance use addiction, congratulations, you have taken the important first step toward recovery. People often feel ashamed of their addiction and stop short of seeking help. This is understandable, considering the misconception around the process of recovery, in addition to the stigma associated with persons in recovery, and sometimes their family.

The good news is that you do not have to go through the recovery process alone. Recovery begins with the courage to seek help and enlisting support from family members or friends. Additionally, if you need pharmacological-assisted therapy, or would like to map out your recovery journey, you may want to consult experts.

In this article, we provide an overview of the substance use treatment and recovery process available at Bangkok Hospital Chiang Mai Mental Health Clinic.

I am not sure that I need addiction treatment. How do I know when to get treatment?

You can start by observing yourself and your interactions with family members or the people around you. Is there any impairment in your ability to function on a daily basis? Sometimes, you don’t think that it’s a problem. But what feedback do you receive from your colleagues or supervisor about your job performance? What does your spouse or family members say about your substance use?

In terms of the symptoms that may alert you to seek treatment, these will vary according to the type of substance that you use. For addiction in general, we follow the DSM-5 assessment criteria for substance use disorders, which focus on impairments in terms of control over substance use, including using a larger amount than originally intended; unsuccessful efforts to discontinue or cut down use; spending a large amount of time obtaining the substance, using the substance, or recovering from its effects; having intense urges or cravings to use.

In addition, there are criteria that focus on social impairments, specifically: failures to complete or fulfill work, school, family responsibilities; problems with interpersonal or social relationships; disruptions to or discontinuation of social, occupational, or recreational activities in order to use a substance. Finally, continuing use despite knowing that the substance produces undesirable physical and psychological effects, as well as having tolerance and withdrawal symptoms.

The level of severity is categorized into mild (2-3 criteria), moderate (4-5 criteria), and severe (6 or more criteria).

What types of substance use treatments are available?

Substance use treatment is divided into two phases: detoxification and rehabilitation. During detoxification, the goal is to eliminate as much substance from the body as possible in order to restore the body function to its baseline before use. When persons in recovery stop using certain substances, such as alcohol, opioids, or nicotine, they can experience withdrawal symptoms; in this case, the standard treatment is to use pharmacological-assisted therapy to minimize complications. Treatment of stimulant-related disorders (e.g. amphetamine, methamphetamine, cocaine) relies on medication to help alleviate withdrawal symptoms, such as dysphoria, body pain, restlessness, and insomnia.

The second phase of treatment is rehabilitation. Rehabilitation targets the psychosocial aspect of recovery, including management of triggers and cravings, communication skills, interpersonal skills, coping skills, self-management skills, and the management of relapses. The approaches used at Bangkok Hospital Mental Health Clinic include cognitive behavioral therapy, motivation enhancement therapy, and relapse prevention.

How does substance use treatment actually work?

Out-patient or in-patient treatment options are available. In many cases, there are underlying mental health issues that also need to be treated.

People who want to quit using, but have never attempted to quit before, and can still function relatively well in daily life, may want to start with the out-patient treatment. Out-patient treatments are part-time programs, allowing the recovering user to keep going to work or school during the day.

At Bangkok Hospital Chiang Mai, our in-patient treatment program is short-term only and intended for users who:

1. Have made multiple unsuccessful attempts to quit
2. Experience severe withdrawal symptoms during detoxification
3. Display symptoms that put themselves or others at risk

Will I be required to stay over at the hospital?

The length of stay depends on the severity of intoxication and withdrawal symptoms.

How long does it take to recover from an addiction?

The length of recovery from addiction depends on each person. Usually, ongoing follow-up appointments last for at least one year. According to the medical standard, early remission means three to twelve months without meeting the full criteria of substance use disorder. If you do not meet the full criteria for 12 months or longer, then you are in a sustained remission period.

Why do some people keep relapsing?

In order to answer this question, we need to understand the process of addiction, which often takes months or years to develop. Over this period of time, users gradually adjust their lifestyle to accommodate substance use. For example, if they drink alcohol, they may start to go out after work and socialize with fellow drinkers, and reduce the time they would have normally spent on other activities. This shift usually happens without the users being aware of it.

The other factor that we need to understand is the purpose of using the substance. Some people smoke or use drugs in order to gain social acceptance, relax after work, or to increase self-confidence. When not using the substance, all the perceived benefits disappear, which makes persons in recovery susceptible to relapse if they have not found a way to handle all of these underlying issues.

In addition to the psycho-social aspect, addiction also affects brain functioning. The brain of substance users has been conditioned to substance use. Without the substance, users often experience cravings or withdrawal symptoms.

In treatment, we aim to reverse this process, as well as helping persons in recovery to restore the psycho-social aspect of their lives. This process is not easy and takes time. It means making changes on many levels and in multiple dimensions of the person’s life. These changes create discomfort. When combined with withdrawal symptoms, it makes a person in recovery susceptible to relapse.

I don’t know if it’s an addiction, or something else, like stress, anxiety, or depression.

Yes, addiction is a complex issue. Substance abuse has a direct impact on a person’s mood. Some people use the substance to change the way they feel. We call this self-medication. When persons in recovery come in for treatment, we may discover that there is actually underlying depression, anxiety, or other co-existing mental health issues and treat them together.

In addition, certain mental health issues, such as bipolar disorder, may lead to substance use. Drinking alcohol helps the person to feel calmer in the beginning. But the alcohol actually increases the severity of manic episodes.

What do I need to do to prepare for the treatment?

Your intention to quit is already a big part of the preparation.

After treatment, will I become addicted again?

Addiction or substance use disorder is a disease that has high relapse rates, between 20 to 90 percent, depending on the treatment setting. Based on these numbers, it is likely that you will have a relapse. Having a relapse, however, does not mean that you fail.

I have a friend/family member who is struggling with an addiction, what can I do to help?

If they still do not see their addiction as a problem, you can try to give feedback using a non-judgmental attitude. Tell them how their use affects you and your relationship with them. Ask them to think about the effects of their substance use.

If they have accepted that addiction is a problem, you can support them to get treatment. Some people want to quit on their own. You can support them by giving support, information, and feedback. Ask what their challenges are and how you can help them to overcome these challenges.

I am a friend/family member of the person in recovery, what can I do to help with the treatment?

The best you can do is to be a good supporter. Caretakers usually blame themselves when persons in recovery struggle with relapse. Don’t take it personally, because this will only prevent you from providing support to the person. Some people get angry, and this only makes it worse.

If you cannot stop yourself from feeling frustrated or angry, it may mean that you also need help. Bring the person and also seek help for yourself.