The rise in the demand for prescription drug treatment was recently documented in a report compiled by the Substance Abuse and Mental Health Services Administration (SAMHSA).  The report included a breakdown of treatment trends for the nearly 2 million people who were admitted for alcohol and drug recovery treatment in 2009.  Opiate drugs accounted for 21 percent of all admissions.  Out of all opiate admissions, 33 percent were for prescription drugs – up from 8 percent in 1999.  What is alarming about this type of addiction is that it often happens to regular people (housewives, business men or women) who are prescribed medication for pain management.  People on these prescribed medications often do not initially abuse them, and instead, a chemical reaction caused by the medication can trigger drug abuse.

The increase in opiate prescription drug treatment can be attributed in large part to the epidemic of painkiller abuse.  Lynn Webster, a director for the American Academy of Pain Medicine, links the explosion in prescription painkiller abuse to a desire on the part of physicians to effectively treat pain. Over the past decade, many doctors mistakenly believed that opiate painkillers like OxyContin and Vicodin were safe and non-habit forming.  The rise in demand for prescription drug recovery has since proven this belief to be naïve.

Many people who abuse prescription drugs will begin to build a tolerance for the drug, meaning that it will take a larger quantity of the drug to achieve the desired effect.  In addition to taking more than the recommended dosage, prescription drug abusers often change the form of the drug, such as crushing or dissolving a pill to make it easier to snort or inject.  This delivers the effects of the drug to the bloodstream more quickly but also increases the risk of addiction and overdose.

Prescription drug abuse and addiction is treatable.  For some drugs, medically-supervised detox is required in order to taper down intake of the drug without serious medical consequences.  For other drugs, the abuser can enter a drug recovery treatment program without detox.  Recovery from prescription drug addiction requires commitment and effort.  For many people, a long-term residential drug recovery program works best.  A residential program provides a safe environment where drug-dependent individuals can concentrate on recovery.

Fortunately, heroin addiction is a chronic disease that can be successfully treated.  Because the physical withdrawal symptoms are extreme, cessation of heroin use should take place in a detox and rehab facility.  Sweating, muscle aches, anxiety, nausea, vomiting and diarrhea are some of the symptoms associated with heroin withdrawal.  These symptoms increase in intensity for the first 48 to 72 hours, then may plateau and continue for 7 to 10 days.  Heroin withdrawal is rarely fatal, but it is so acute that it has a high failure rate when attempted without professional support.

A heroin detox and rehab facility can help control withdrawal symptoms with medication and medical support.  Methadone, a synthetic opiate that eliminates withdrawal symptoms and blocks the effects of heroin, is the most common pharmaceutical used for heroin addiction.  Other medications such as buprenorphine are also used for heroin detox and rehab.  The best detox and rehab programs strive to provide a safe and humane environment where heroin withdrawal can be undergone with minimum symptoms and complications.

Detoxification is not a treatment for addiction, but it will help a recovering addiction adjust to a heroin-free state.  The National Institute on drug abuse reports that the most effective post-detox treatment for heroin addiction is a residential treatment program that lasts from 3 to 6 months.  A heroin treatment program will address the psychological effects of withdrawal.  Cravings for the drug will continue long after the physical effects are gone.  Because cravings can be worse when the period of addiction has been longer, treatment for heroin addiction is most effective when it occurs in the early stages of abuse.

Heroin detox and rehab programs deal with addiction on multiple levels.  There should be some level of personalization in order to effectively treat each individual case of addiction.  Besides physical withdrawal, the psychological and emotional issues must be addressed.  Treatment programs that provide medication as well as one-on-one therapy, group sessions and exercise provide the best environment for overcoming heroin addiction and gaining necessary skills for living heroin-free in the real world.

Intake Interview and Assessment

The first step in rehab treatment is a comprehensive interview with the person who is being admitted.  The information obtained from this initial assessment will allow the rehab center to determine the best treatment program.  The rehab center’s staff will ask for a medical history and details about the patient’s addiction.  Medical tests such as urinalysis or a blood test may be performed.

Detoxification

Most forms of addiction require a period of medically-supervised detoxification.  The goal is to wean the patient from the physical effects of the abused substance and to remove all traces of the substance from the patient’s body.  Because withdrawal symptoms can be severe and even life-threatening, some rehab centers require a patient to undergo detox in a hospital or clinic before being admitted for treatment.

Substance Abuse Treatment

Following detoxification, the substance abuse treatment phase begins.  During the treatment phase, a rehab center will use a variety of methods to address the problem of addiction.  One-on-one counseling and group therapy are the most common forms of treatment.  Some treatment programs center on the 12-step model, while others are based on cognitive behavioral therapy and other forms of therapy.  The recovering addict must learn to recognize the triggers of substance abuse and adopt coping skills that will allow him or her to resist relapse.  Many rehab centers also offer occupational therapy and exercise programs to engage patients who are fighting the cravings of addiction.

A patient’s type of addiction, frequency of use and length of addiction will determine the duration of rehab center treatment.  Addiction experts recommend at least 30 days for inpatient rehab treatment; rehab center stays of 60 to 90 days are often required.  During the early weeks of treatment, visits from family and friends may be restricted.

Rehab Aftercare

The most important thing to remember about the first 30 days of rehab treatment is that it is the beginning of a lifelong journey.  When a recovering addict or alcoholic leaves a rehab center, a plan for aftercare treatment should be discussed.  Aftercare therapy and support will help avoid relapse and maintain long-term sobriety.  The family of the person in recovery should also receive follow-up counseling to help them understand their loved one’s addiction and to educate them on the best ways to support sobriety.

Drug addiction completely alters an addicted individual, making him or her unrecognizable to loved ones.  Watching the downward spiral of addiction, family members experience a wide range of conflicting emotions that may include anger, disappointment, frustration, concern, fear and betrayal.  They may have a strong desire to cut all ties with their addicted loved one.

An integral part of the drug recovery process is putting back together the pieces of a life that was shattered by addiction.  The family should play an important role in supporting the recovering drug abuser.  This usually requires mending broken relationships and re-establishing a sense of trust.  Many treatment programs provide family therapy to help members of the family learn more about their loved one’s drug dependency and to address their own issues that may be related to the problem.

There are three main goals for family therapy during drug recovery:

(1)   Help the family understand the nature and extent of their loved one’s addiction.

(2)   Create or strengthen a family support system that will aid in their loved one’s drug recovery.

(3)   Provide treatment for family members for emotional and psychological damages caused by the addiction.

Family therapy will help family members develop coping mechanisms through group therapy sessions, educational lectures and one-on-one counseling.  The family will learn that there is no cure for drug addiction and that drug recovery is an ongoing process.  By providing love and support, they can help their loved one avoid relapse and continue to progress on the road to recovery.

Detox is the process that cleanses the body of a substance that has been abused.  It begins when an addicted person stops using the abused substance continues until the most serious physical symptoms of withdrawal have abated.  Rehab refers to a rehabilitation treatment program that follows detox.  It may consist of outpatient counseling sessions several times a week or involved a residential treatment center where a recovering addict lives for several weeks or months.

How long do detox and rehab take?

Because each case of addiction is individual, there is no standard timetable for detox and rehab.  In general, rehabilitation should be thought of as at least a year-long process.  This doesn’t mean that a recovering addict must stay in treatment for an entire year, but he or she should have access to treatment resources for that period of time.  Once a year has passed, addiction recovery should be thought of as a life-long process.

Do detox and rehab really work?

Detox and rehab work best for addicted individuals who are committed to recovery.  There are many forms of treatment and some have higher success rates than others.  The best programs will provide a safe and humane environment for detox and rehab and equip the recovering addict with coping skills that can be used on a daily basis to avoid relapse.

What’s the best way to find a detox and rehab program?

There are a variety of ways to locate detox and rehab programs.  The Internet is a powerful tool for searching for treatment programs and finding out more about them.  Medical professionals and addiction support groups are good sources for treatment program recommendations.  When you’ve found a program that you’re interested in, visit the facility and find out more about their detox and rehab procedure.

Do detox and rehab only work when a person wants help?

It’s best to approach addiction treatment with an open mind, but that’s not always possible.  Many people enter a treatment program unwillingly following an intervention by family and friends.  They experience a life-altering change following detox and are able to that successfully complete rehab treatment.

I recently interviewed a married couple who shared the story of their experience with alcohol detox and delirium tremens.  Ann and Steve (not their real names) are the parents of two teenage boys.  Shortly after the birth of their youngest son, Steve became anxious and began to increase his alcohol consumption.  Soon he was consuming 2 six packs of beer per day and getting up in the middle of the night to drink wine.  He stopped eating regular meals and his personal hygiene suffered.

Steve had previously been very athletic and health-conscious, so Ann was naturally concerned about the change in his behavior.  She finally talked him into making an appointment with their family doctor.  The day before his appointment, Steve decided to stop drinking.  Over the next few hours he became increasingly agitated.  He became extremely pale, his hands began to shake and he was nauseous.  Suspecting that Steve was going through severe alcohol detox, Ann took their children to a sitter’s house.   When she returned, his condition had worsened.  He had been vomiting and now he had dry heaves.  He decided that a glass of wine would help “calm his nerves.”  As he stood up to go to the kitchen he emitted an involuntarily yell and fell to the floor in a grand mal seizure.

Ann recognized what was happening and did what she could to keep Steve from harming himself during the seizure, which lasted just a minute or so but seemed longer.  She then called the doctor’s office and was told to get Steve to an emergency room as soon as possible.  Steve was in a dazed state, but with a neighbor’s help Ann was able to get him into their van.  (Later she would wonder why she had not called 911).  He lay on the floor during the short drive to the hospital and was unconscious by the time ER workers placed him on a gurney.  In the emergency room, Steve suffered three more grand mal seizures.  Based on comments made by ER personnel, Ann knew his alcoholism was life-threatening situation.

Steve was admitted to the hospital and given medication to help him sleep.  When Ann returned the next day, he was sitting up in bed and talking.  He was far less agitated but was delusional, referring to the hospital as a school and the nurses as teachers.  He remained delusional for the next 24 hours and Ann began to wonder if he had suffered irreversible brain damage.  By the next day he was more rational and though in a weakened state was ready to be released.  Before Steve left the hospital, his neurologist told him that his alcohol detox had nearly been fatal.  If he wanted to see his sons grow up he would have to stop drinking immediately.  The doctor’s words affected Steve deeply.  He successfully completed alcohol treatment and has remained sober for more than a decade.

Alcohol Substance Abuse and Early Childhood Experiences

Researchers have found that there appears to be a link between a drinker’s early childhood experiences and the use of alcohol to deal with stress.  Exposure to traumatic experiences in infancy and childhood may shape an individual’s stress response and contribute to a predisposition for alcohol substance abuse.  The relationship between stress and alcohol abuse is even more marked when healthy coping mechanisms and a strong social support system are not present.

According to the National Institute on Drug Abuse, children and teenagers who experience trauma from violence or a disaster have a greater change for developing drug or alcohol substance abuse problems later in life.  Early intervention for depression and anxiety can help reduce the risk of substance abuse.  The Anxiety Disorders Association of America reports that about 20 percent of Americans who have been diagnosed with an anxiety or depression have a drug or alcohol substance abuse disorder.  Ironically, the symptoms of one disorder can worsen the symptoms of the other.

Stress and Alcoholism Relapse

While there is no evidence that stress alone will lead to alcoholism, stress can be a factor in alcoholism relapse.  Recovering alcoholics who suffer a relapse will often cite chronic stress as the reason that they began drinking again.  One way to avoid this type of relapse is by meeting with other recovered drinkers and creating a network of support.

Getting help for an alcohol substance abuse problem will not eliminate problems related to stress and anxiety.  Both problems should be treated at the same time in order to reduce the chances of alcohol abuse relapse.

Experts in alcoholism draw a distinction between alcoholism (also known as alcohol dependence) and alcohol substance abuse.  For alcoholics, every aspect of life is affected by their drinking, including relationships, work, finances and health.   Despite the enormous difficulties in their lives caused by alcohol, they continue to drink.  Those who are described as alcohol substances abusers are in an earlier stage of the disease.  Their alcohol use has some self-destructive aspects, but they have some control over the problem and are able to set limits on their drinking.

Many alcohol substance abusers are at high risk of becoming alcoholic. Some alcohol abusers move into alcoholism following a crisis or life-changing event, such as divorce, loss of a job or death of a loved one.  For other alcohol abusers, the shift to alcoholism is gradual.  They begin to drink more as their tolerance for alcohol increases or they start to spend more time focusing on drinking.

Anyone who drinks needs to be aware of the warning signs of alcohol substance abuse:

• Taking risks with alcohol.  This may include drinking and driving or mixing alcohol with prescription drugs.
• Ignoring responsibilities and commitments. Due to drinking or a hangover, responsibilities at work, home or school are neglected.
• Continuing to drink despite problems.  Even though relationships are suffering, the drinker does not change his or her behavior.
• Needing alcohol to relax. Alcohol once made the drinker feel good, but now is needed to avoid feeling bad.

Alcoholics also exhibit these signs, but in addition they have developed a physical dependence on alcohol.  They need alcohol to function on a daily basis and have a physical urge to drink.  They have developed a tolerance for alcohol, which means that over time they have to increase the amount of alcohol they drink to feel the same effects.  When they stop drinking, they experience physical withdrawal symptoms.  Even if they want to stop drinking, it may not be possible.

There are a wide variety of treatment programs available for alcoholics and alcohol substance abusers who recognize that they have a problem.  Outpatient treatment programs, residential rehab and 12-step support groups are just a few of the options for recovery.  The most important step on the road to recovery is reaching out for help.

Doctors make a diagnosis of alcohol withdrawal when two or more of the following occur within a few hours or a few days after drinking has stopped:

• Insomnia
• Hand tremor
• Heartbeat greater than 100 beats per minute
• Nausea and vomiting
• Visual or auditory hallucinations
• Delusions
• Anxiety
• Agitated movement
• Grand mal seizures

According to the Association of American Family Physicians, alcohol detox can effect long-term changes on neurons in the brain, especially when a drinker undergoes detox more than once.  Recurrent detox episodes are believed to increase alcohol cravings.  It is also believed that withdrawal and detox will become progressively more serious each time it is experienced.

Many people who are undergoing alcohol detox and withdrawal can be treated as outpatients, but severe cases require hospitalization.  When severe symptoms of delirium tremens are present, especially hallucinations and seizures, a doctor should be consulted immediately.  The U.S. National Institutes of Health reports that the mortality rate for delirium tremens is approximately 15%.  Another reason for consulting a doctor during severe alcohol detox is that there is always a chance that what appear to be alcohol detox symptoms are actually indicators of another medical condition, especially if seizures occur more than 48 hours after the last drink was taken.

The goals of treatment for alcohol detox are to help the patient safely complete alcohol withdrawal and to prepare the patient for immediate treatment for alcohol dependence.  Depending on the patient’s condition, medication may be administered to lessen the severity of alcohol detox symptoms.  Treatment of withdrawal symptoms alone will not address the underlying disease of addiction or help the patient achieve long-term abstinence from alcohol.

The 12-step philosophy is based on these principles:

• Admitting that you are powerless in the face of addiction.
• Recognizing that there is a Higher Power that can help restore your sanity.
• Turning your life over to the Higher Power.
• Examining your life and making amends for past errors.
• Continually working towards your own and others’ recovery.

The concept of support is key to 12-step programs.  It takes the form of support groups that assist in the recovery process and individual sponsors who provide one-on-one guidance.  A sponsor is a successfully recovered alcoholic who acts as a mentor and is available in times of crisis to help a recovering alcoholic avoid relapse.  Rehab centers that use a 12-step program use support groups throughout the treatment process.

Some alcohol rehab centers combine a 12-step approach with other treatment options which may include personalized individual counseling and family therapy.  Holistic treatments like yoga, meditation and nutritional counseling are also provided to help recovering alcoholics develop new life skills and coping mechanisms.

Many recovering alcoholics join Alcoholics Anonymous following release from a rehab center that utilizes a 12-step program.  They are assigned a sponsor and continue with group support sessions at Alcoholic Anonymous meetings.  Studies show that following up rehab center treatment with a program like AA increases the chances of maintaining sobriety over the long term.