Treatment And Interventions

Treatment refers to interventions that seek to improve the physical, emotional and psychological health and well-being of people who use or have used substances (and sometimes their families) through various psychosocial and psychopharmacological therapeutic methods, with the goal of stopping or managing substance use.

Effective treatment is evidence-based, easily accessible and has the active involvement of the person being treated. Examples of treatment include withdrawal management (detox), residential and outpatient treatment, counselling and substitution therapies (e.g. methadone maintenance therapy).

It is generally agreed there are not enough treatment spaces or options available; waiting lists are common. A Vancouver-based study found that street youth who already using substances are twice as likely to start injecting drugs, in the event that they are unable to access treatment for their addiction. Injection drug use puts these youth at an increased risk for acquiring HIV and Hepatitis C. In any case, there are limits to treatment. It may also be impossible to force people to receive treatment as many people with substance use problems avoid or reject traditional treatment -- treatment is usually the last resort.

A successful approach to substance use recovery would mean an individual has agreed to treatment and has diligently worked through many stages of rehabilitation. According to Prochaska and DiClemente’s Stages of Change Model: A Stepped Approach to Addictions, the stages of treatment are: Pre-contemplation (the individual has no intention of changing); Contemplation (the individual develops an awareness of the problem as the individual weighs the pros and cons of taking action); Preparation (the individual in this stage has decided to act and makes plans to do so in the near future); Action (the individual modifies his or her behaviour, experiences, or environment to overcome the problems); and, Maintenance (the individual maintains the behaviour that occurred in the action stage, works to prevent relapse, and consolidates the gains that have been attained).

It is suggested the vast majority of people that seek substance use services (85% to 90%) are not in the action stage. If a person is not in the action stage, providing treatment or having an intervention may lead the person to reject the idea of treatment entirely. Therefore, engagement of the individual must be accomplished by providing services that meet an individual’s present level of change rather than providing services that are only relevant to an individual in the action or maintenance stage.

Overall, fewer than 20% of those who seek treatment complete it -- but for those who do complete treatment, substance use is typically reduced by 40 to 60 percent.

The National Institute on Drug Abuse suggests that there are 13 principles to effective treatment of substance use disorders: 

  • The complex but treatable nature of addiction,
  • No single treatment is suitable for everyone
  •  Treatment needs to be accessible,
  • Dealing with individuals’ multiple needs, rather than simply focusing on the addiction issues
  • Staying in treatment for an adequate amount of time
  • Behavioural therapies in their different forms
  • Medication, possibly combined with counselling interventions
  • The need to continually modify the individual’s treatment and service plan
  • Dealing with the other disorders that commonly co-occur among people who use drugs
  • Drug detoxification as the first step of treatment, using medical supervision
  • Sometimes treatment won’t always be voluntary, but can still be effective
  • The need to monitor the individual closely, and the fact that lapses during treatment do happen
  • Treatment programs should include testing for various diseases such as HIV, Hepatitis B and Tuberculosis, as well as risk-reduction counselling and treatment

Similarly, the World Health Organization (WHO) and United Nations Office of Drugs and Crime (UNODC) has International Standards for the Treatment of Drug Use Disorders. This includes principles of having accessible treatment and ensuring ethical standards in treatment services.

Decades of research have established a variety of addiction treatment methods that are as successful, including both behavioural therapy and medication. Recovery from dependence can be a lengthy process and frequently requires multiple or prolonged treatment episodes. Lapses during the course of treatment are common and do not indicate that treatment is ineffective. In fact, it is critical that lessons from lapses be identified and integrated into the treatment process. To be most effective, treatment must be readily available, tailored to individual needs, and part of a comprehensive plan that addresses associated medical, psychological, vocational, legal, and other social needs. Lastly, treatment success needs to be measured through improvements in the quality of life and health status of the affected individuals.