How is substance abuse treated? Can it be cured permanently?

Substance abuse is a progressive illness which leads individuals to lose control of the use of some substances inspite of deterioration in health and other aspects of life. Generally, people perceive substance use as a factor of will, which can be easily stopped when an individual feels like doing that. The reality cannot be further than that. Substance use like alcohol, cigarette, weeds, ganja, and drugs can be very hard to stop after taking it regularly and in increasing doses. Proper treatment procedures are there for treating substance abuse. Intensive treatment and therapy are required to fight the battle against substance use.

1. Pharmacotherapy: For treating people with substance abuse, medication plays a huge role. Medicines are used to manage cravings, dealing with withdrawal symptoms and to prevent relapse. Most of the time, medications are used to achieve full remission. One has to meet Psychiatrist for treating substance use through medicine.
2. B Counselling: There are different counselling techniques which are used for treating children, adolescents and adults with substance use. Counselling is generally given by psychologists with specialisation in clinical psychology/addiction. The different counselling techniques used are:

• ✔ Brief Intervention: Brief Intervention is a treatment modality that has been found effective and easy to deliver especially in non-dependent harmful/hazardous substance users including adolescent substance users. The main steps of the therapy are:

  1. Assessment and Direct Feedback: In the first step, the pattern of substance use is assessed, usually with help of an objective scale (For example, CAGE for alcohol use).
  2. Negotiation and Goal Setting: Goal setting is the most important stage of Brief Intervention. In BI, simple objective, small term goals are established.
  3. Behavioural Modification Techniques: The primary triggers and high risk situations are identified through analysing behaviour of the client
  4. Self-Help-Directed Readings: A workbook provides the individual and counsellor with opportunities to discuss the individual's cues for using substances, reasons for using substances, and reasons for cutting down or quitting.
  5. Follow-up and Reinforcement: This step involves a summary of the discussion and a review of the agreed-upon changes.

• ✔ Motivational Enhancement Therapy (MET): MET focuses on improving an individual's motivation to change. Those who engage in substance use can be sometimes confused and have little motivation to change such behaviours. A trained counsellor can help an individual to sight behaviours objectively and try to initiate the process of change. The steps of MET are:

  1. Feedback on personal risk relative to population norms is given to clients after substance use assessment.
  2. Responsibility for change is placed with the client.
  3. Advice about changing the client's substance use is given by the counsellor nonjudgmentally.
  4. Menu of options and treatment alternatives is offered to the client.
  5. Empathetic counselling style (i.e., warmth, respect, an understanding) is demonstrated and emphasized by the counsellor.
  6. Self-efficacy is supported by the counsellor to encourage client change.

• ✔ Relapse Prevention Therapy: It is designed to teach individuals how to anticipate and cope with relapse. Relapse is less likely to occur when an individual possesses an effective coping mechanism to deal with high risk situations. The basic goals of Relapse prevention therapy are A. Understanding relapse as a process, not an event, B. Identifying and coping with high-risk situations C. Coping effectively with urges and cravings D. Creating a more balanced lifestyle. The steps of RPT are:
  1. Detecting High Risk Situations: In RPT, the High Risk Situation encompasses all the situations in which the chances of taking a substance is more than in other situations. The high risk situations can be:



Situation	Example
Specific place	The place from where client used to buy substance, place where client used to gather with friends and take substance
Specific time	Specific time of the day (e.g when a person usually used to take substance, specific time of the year (e.g festival like Holi or Diwali)
Specific emotion	Specific emotions like sadness, happiness or anger increases the urges to drink
Specific People	Substance taking peers which leads to direct or indirect persuasions to take substance
Stress	Stressors like family conflict, job loss, death of family member or critical comments

2. Learning New Coping Skills: After detecting the high-risk situations two types of coping strategies are taught. A. Teaching the client to recognize the warning signals associated with imminent danger—that is, the cues indicating that the client is about to enter a high-risk situation.
3. Managing Outcome Expectancies: Some people focus on the positive outcome expectancy of substance and depend on it to accomplish certain short-term goals e.g. alcohol helping to deal with grief and stress, excessive smoking before exams to deal with stress.
4. Life-style Modification: In RPT, importance is given to managing the life-styles. Initially assessment is done by approaches in which clients self-monitor their daily activities, identifying each activity as a “Pleasurable” “Necessary” or combination of both. Striking a balance between pleasurable and necessary activities are important and modifications are done in accordance to that.

There is no complete cure to substance use, but through taking above mentioned treatment options, one can overcome addiction and stay substance-free. Long-term follow-up is imperative in preventing relapse.

Also read,

What is substance abuse? What are the 4 types of substance abuse?

What are the signs of substance abuse and how does it affect the mental health of an individual?