What Is Addiction?
According to the American Psychiatric Association, addiction is a complex brain disease. It’s characterized by compulsive substance use, in spite of the occurrence of harmful effects and consequences. When someone is addicted to a substance, they are almost entirely focused on using that substance. It then takes over their life. They are also highly focused on making sure they’re able to obtain more of whatever it is.
If someone uses alcohol or a drug to the point where it’s creating problems, and they know that it’s going to do so, but they can’t or are unwilling to stop, it’s likely an addiction.
Some of the substances people develop addictions to include:
- Opioid pain medications like oxycodone
- Illegal opioids like heroin
- Hallucinogens like LSD
- Sedatives such as anxiety medications or sleep aids
- Stimulants like cocaine
When someone is addicted to a substance, it creates dangerous and often long-term changes in the brain.
The National Institute on Drug Abuse defines some of the most common reasons people begin taking drugs. These reasons include:
- To feel a pleasurable high or a sense of euphoria
- To feel relaxed or to cope with stress
- To improve their performance in some area
- Because of curiosity or peer pressure
There are many addiction treatment resources available to people, but not everyone who struggles with an addiction is willing to seek help. Often it is their loved ones who research rehab programs and treatment programs for them, and they may need to stage an intervention in order to persuade their loved one to go to treatment.
Not all addiction treatment options are the same. There are different types of programs, differing costs and different approaches to the treatment of addiction. The following offers an overview of what to know about how addiction is diagnosed, how it’s treated, and what types of treatment programs are available.
What some people may not understand about addiction is the fact that it can be diagnosed, as is the case with other diseases. There are criteria that a medical professional including a mental or physical healthcare provider can look at, and can determine whether or not a patient might have an addiction problem.
In order for someone to be diagnosed as having an addiction, there should be at least three of the following symptoms:
- The person has developed a tolerance, meaning they need larger doses to get the desired effects
- There are symptoms of psychological and physical withdrawal that occur when the patient attempts to stop using the substance or cut down
- The user often takes higher doses than what they intended to take
- There are attempts to stop or cut down on the use of the substance, but these attempts are unsuccessful
- A significant amount of time and attention goes toward using the substance and trying to get more of it
- Someone with an addiction will typically give up other interests or activities to use the substance or to recover from its effects
- Despite the known adverse effects, someone continues to use the substance
The symptoms that can be used to diagnose addiction are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association.
If someone is diagnosed as having an addiction, it can further be characterized as mild, moderate or severe. This is determined by looking at the number of the above symptoms that a person demonstrates. If a person has three or fewer, they may be diagnosed as having a mild addiction. In sometimes, three to five may be diagnosed as moderate, and any more than that is considered a severe addiction.
Treatment plans should be highly individualized, and one consideration when treating addiction is the severity of the problem, although there are many other factors that come into play as well.
So, how many people actually receive treatment for an addiction? The following numbers are based only on publicly-funded rehabs, but they do give a general idea.
- The National Survey on Drug Use and Health estimates there are 20.8 million people in the U.S. who currently meet the criteria for having a substance use disorder—this is around 7.8 percent of the total population
- Of those people, it’s only estimated that around 2.2 million receive any kind of treatment
- The percentage of admissions to rehab and addiction treatment centers for people who only have an alcohol problem is around 23.1 percent of the total
- Alcohol plus another an addiction to another substance accounts for 18.3 percent of admissions to publicly funded rehabs
- 17 percent of admissions are for marijuana addictions
- 1 percent of people who go to publicly-funded rehab centers do so for crack addiction
- 5 percent of admissions are for amphetamines and stimulants
- 9 percent are for opiates
- 2 percent are for cocaine
- 6 percent of admissions are for tranquilizers
There are other estimates indicating around 23 million people in the U.S. have an addiction problem, but only 10 percent of those people seek and receive help. That would leave around 20 million people not getting addiction treatment. This is an especially startling statistic considering around 115 people die each day from overdoses.
Addiction Treatment Approaches
Addiction to any substance, whether it be alcohol, prescription pain medications, tranquilizers or stimulants, is a chronic disease of the brain. Over time as the brain is exposed to the effects of certain substances, its functionality changes.
Because addiction is considered a chronic disorder, it’s important for people to understand that there isn’t necessarily a “cure.” This is similar to conditions such as diabetes. While there isn’t a cure, the disorder can be treated and managed. This understanding is central to finding quality addiction treatment.
Any addiction treatment program should be focused on helping people become sober, and learn how to live their lives going forward without the use of drugs or alcohol.
The NIH National Institute on Drug Abuse created a list of some of the criteria that should be part of an addiction treatment program, to maximize effectiveness and improve long-term outcomes. The principles of effective treatment according to the National Institute on Drug Abuse include:
- Addiction is treatable but is a complex disease affecting behavior and the function of the brain
- There’s not one approach to treatment that’s going to be effective for everyone
- Access to treat needs to be readily available
- Treatment should be holistic in that it addresses all of the needs of the patient and not just his or her drug use
- Staying in a rehab or treatment program for long enough is vital
- Behavioral therapies and counseling should be the cornerstone of an effective treatment program
- Medication may be used as part of an addiction treatment program but medicine alone isn’t usually sufficient to help someone addicted to drugs or alcohol
- A treatment plan should be not only individualized but also regularly reviewed to ensure it is continuing to meet the needs of the patient
- A medical detox isn’t a treatment itself—it’s just the first step of treatment
- Someone doesn’t have to voluntarily go to treatment for it to be effective
- It’s important to include monitoring of any potential drug use during treatment
Generally, the treatments for addiction include behavioral counseling, medication, and evaluation and treatment for co-occurring psychiatric disorders. Long-term follow-up is also important to prevent relapse.
The first step of addiction treatment for most people is a medical detox. The majority of substances people become addicted to also lead to physical dependence. If you have been using, for example, alcohol for a long period of time and you stop suddenly (called going cold turkey), you will likely have symptoms of withdrawal. These symptoms can be mild or they can be severe. Some substances, including alcohol, can also have deadly withdrawal symptoms.
Before someone can begin addiction treatment, they will need to detox from any and all substances they are using. Medical detox isn’t an addiction treatment program, but it can be life-saving.
During a medical detox, patients are assessed and monitored. A 24/7 medical staff makes sure the patient isn’t experiencing dangerous complications as the result of withdrawal. The patient’s comfort is important during this time as well.
Only once someone has fully detoxed from the substances they’re dependent on can they continue into the rest of an addiction treatment program.
Inpatient or Residential Rehab
Once someone has fully detoxed, the next step they will usually take is begin admitted to an inpatient rehab program. Inpatient rehab is also called residential treatment. When most of us think of rehab, an inpatient program comes to mind first.
Residential treatment requires patients stay overnight in the treatment facility and while they’re there, they are constantly supervised and monitored. If you think about the chaos surrounding addiction, it can be a comfort for a lot of people to go into the controlled environment of inpatient rehab.
There are a lot of specific types of inpatient or residential rehab. For example, short-term rehab is usually a program that lasts for 30 days or less. It may include an onsite medical detox. Once someone completes their 30-day program, they might be advised to continue with treatment on an outpatient basis.
There are longer-term inpatient rehabs as well. For example, therapeutic communities are long-term rehabs especially beneficial for people with severe, ongoing addictions. These programs are intended to help patients become resocialized along with helping them stop using drugs or alcohol.
There are also sober living houses. This is a transitional step for a lot of people following inpatient rehab. Sober living houses have quite a bit of supervision, but less than inpatient rehab.
Partial Hospitalization Programs (PHP)
A partial hospitalization program is one that is similar in intensity to inpatient rehab. Patients are expected to participate in scheduled treatment and therapy for most of the day, and it’s held almost every day of the week in a lot of cases. An average stay in a PHP might be around five days.
The biggest difference between a PHP and an inpatient rehab is the fact that patients can return home, or to their recovery housing each night when they complete treatment in a PHP. Patients in a PHP do have more freedom and autonomy. They are responsible for managing their behavior and avoiding relapse while they are not at the treatment center. This allows patients to test what they’ve learned during treatment in real life scenarios.
Intensive Outpatient Programs (IOP)
An intensive outpatient program or an IOP is one specific type of rehab that takes place on an outpatient basis. An IOP requires less of a time commitment than a PHP, but more than a traditional outpatient program. During an IOP for example, a person might be required to attend treatment several hours a week. The scheduling can be flexible around the other things they have to do each day, such as school or work.
Outpatient treatment doesn’t require participants to stay in a facility overnight, and the time commitment is fairly minimal especially compared to other forms of addiction treatment. Even a basic drug education program can be characterized as outpatient treatment.
Most people don’t just participate in one type of treatment program. Instead, it’s usually a process. For example, someone might start with a medical detox. Then once they have fully detoxed they may begin inpatient rehab. Following the successful completion of their inpatient rehab program, they may move into a lower level of outpatient care.
Medication-assisted treatment or MAT is an approach to drug and alcohol addiction treatment that combines medicine with behavioral therapy. The idea is that MAT is a holistic approach to treating certain addictions.
MAT for Opioid Use Disorder
Opioids are drugs that include prescription pain medications and heroin. Opioids are highly addictive, and they are one of the leading causes of overdose deaths in the U.S. The problem with opioids is so severe that it’s often referred to as a crisis or an epidemic.
Medications can be used for opioid treatment, and these drugs are approved by the FDA. Some of the drugs used to treat opioid use disorder are controlled substances that can only be provided to patients in certain situations.
Some of the FDA-approved medications for opioid use disorder include:
- Methadone: Methadone is one of the most commonly used drugs for people with opioid addictions, however it’s also controversial. Methadone is a mild opioid itself. When it’s given to someone, it can fill the opioid receptors in the brain, preventing withdrawal symptoms. Methadone can lead to addiction and dependence on its own, however. Rather than being something patients use in the short-term as they’re receiving opioid addiction treatment, methadone tends to become something people use for years.
- Buprenorphine: Buprenorphine is a type of mild opioid like methadone, but it’s faster-acting. It can help eliminate opioid cravings and stop withdrawal symptoms in a dependent person. Buprenorphine tends to have less of a potential for abuse than methadone, but still the risks can be similar if buprenorphine isn’t used in a well-monitored situation.
- Naltrexone: This is a drug that is different from methadone and buprenorphine. Naltrexone helps block the effects of opioids, such as euphoria. If someone is on naltrexone and they relapse on opioids, they won’t feel euphoric or high.
- Naloxone: Naloxone is a medication-assisted treatment in technical terms, but it’s not used to prevent cravings or withdrawal. Instead, naloxone is designed to help people experiencing an opioid overdose. If someone is showing signs of an opioid overdose, naloxone can be administered. It will knock the opioid drugs out of receptor sites, and stop the overdose.
There are also FDA-approved medications used for the treatment of alcohol use disorder. These drugs aren’t a cure for alcoholism, but they can be helpful for people who are alcoholics and who are participating in a comprehensive addiction treatment program. The medications for alcohol use disorder are:
- Disulfiram: Disulfiram is a medication used to help treat chronic alcoholism. It’s best suited to someone who’s already gone through detox. It’s a tablet taken once a day and if it were taken while someone was intoxicated or within 12 hours after drinking because it can cause side effects like nausea, vomiting, headache and breathing problems. This can occur if someone has even a small amount of alcohol near the time they use the medication.
- Acamprosate: This medication is for people who have already stopped drinking, and who want to remain alcohol-free. It doesn’t prevent alcohol withdrawal symptoms, but it can help people avoid drinking. It can be taken up to three times a day.
- Naltrexone: Naltrexone can be useful to help treat alcoholism as well as opioid use disorder. Naltrexone blocks the feelings of being drunk and intoxicated. It can help people stay motivated to remain in treatment for long enough.
Specialized Rehab Programs
There are a lot of different and often specialized addiction treatment programs available. Just a sample of these can include:
- Wilderness rehab
- Rehab centers based on the 12 steps
- Dual diagnosis treatment centers for people with co-occurring psychiatric disorders
- Centers for trauma or sexual abuse survivors
- Rehab geared toward pregnant women
- Centers for people who are long-term drug users
- Rehab programs for people who have chronic pain issues
- Women or men-only treatment centers
- LGBT-friendly rehab
- Religious rehab
- Alternative or holistic rehabs
- Luxury rehab
- Non-profit rehabs
- Government-funded addiction treatment centers
Dual Diagnosis Treatment
Dual diagnosis treatment is very often something a person requires when they are struggling with addiction. When someone has a co-occurring disorder it means that in addition to a diagnosed addiction, they have another mental health disorder. This could include bipolar disorder, anxiety, depression, or a personality disorder. In most cases, someone with a co-occurring disorder doesn’t know they have it, and they haven’t previously been treated for that disorder.
Why it’s common for addiction to exists with other mental health disorders is because people will use drugs or alcohol to treat and self-medicate the symptoms of the disorder. Over time, drugs and alcohol can actually worsen the symptoms of the mental health disorder, even if they dull the suffering temporarily.
It is very difficult for someone who is suffering from a co-occurring psychiatric disorder along with a substance use disorder. It can feel like an incredibly chaotic, scary and out-of-control situation. For someone to be fully treated for their addiction, they really need to be treated for the mental health disorder as well.
Many rehab centers do offer dual diagnosis treatment. When a patient first begins treatment, the professional team will assess them for co-occurring disorders. If there is a diagnosis, it can be treated at the same time as the addiction with therapy, medication or a combination of both.
When someone has a co-occurring disorder, they usually need an inpatient rehab along with ongoing follow-up care and counseling. Specific elements that are often included in a dual diagnosis addiction treatment program include:
- Medication management
- Mood stabilization and monitoring
- Education on coping skills and stress management
- Working to address underlying issues that play a role in the addiction and the co-occurring diagnosis
- Family or couples counseling
The Cost of Addiction Treatment
There can be a sense of apprehension from people who may need rehab or addiction treatment because they worry about the cost. Rehab, particularly inpatient treatment, can be expensive. However, without high-quality addiction treatment the expenses a person and their family accrues will usually be much higher than treatment would have costed. For example, someone with an ongoing, untreated drug or alcohol addiction is likely to have high medical bills, legal bills, and other similar costs. The ultimate cost of untreated addiction can be death.
Inpatient rehab can cost anywhere from $15,000 to $27,000 on average, for a full, comprehensive program. That cost could include medication management, counseling, group therapy, ongoing therapy, and the cost of room and board during the time a person is in treatment.
There are different ways for people to pay for the cost of addiction treatment.
First, private insurance will often cover at least a portion of the costs of an addiction treatment program. The Affordable Care Act requires that all insurance plans cover behavioral and mental health services as well as substance abuse services. While the use of private insurance can significantly reduce out-of-pocket expenses that someone or their family has to pay for treatment, this can limit the care options available to someone. They will have to attend a treatment center that’s allowed by their insurance coverage.
Another option for someone who wants to go to rehab is to pay using loans. Private loans will require a credit check, and probably information about the person’s income. However, the interest rates on a private loan are going to be lower than a credit card.
Families and individuals can opt to pay on their own using savings as well.
The ACA and Rehab
While there has been a lot of debate surrounding the Affordable Care Act (ACA), it’s something that people should be aware of, if they or their loved one could benefit from addiction treatment.
If someone is hoping to use their insurance to pay for rehab, the rehab center will first conduct an assessment before they’re admitted. During this time, the rehab center will call the insurance company to determine what level of eligibility a person might have. The rehab center can assess the detailed benefits that come with the potential patient’s insurance policy. During this time the rehab center will also put together a cost estimate.
While the ACA does provide more options for people to pay for addiction treatment, what’s actually covered by insurance can vary pretty significantly. There are specific considerations to be aware of including co-payments and cost-sharing.
The time it takes for the insurance verification process can take anywhere from 24 to 48 hours in most cases, and once all the financial and insurance information are gathered, the patient can start moving toward being admitted to the treatment center.
A significant number of rehab centers not only accept private insurance, but they also have sliding-fee scales. This means that someone with a lower income may pay less for addiction treatment than someone with a higher income.
The Family and Medical Leave Act (FMLA)
Aside from the cost, another barrier some people have when it comes to receiving treatment is the fact that they don’t know how they’ll take the time off work. Some people may be able to have protection from losing their job or being punished at their job because they attend a residential rehab center. This protection falls under what’s called the Family Medical Leave Act or the FMLA.
This federal law requires employers provide eligible employees with time off of up to 12 weeks in a 12-month period for specifically covered family and medical reasons.
Not everyone is eligible for FMLA protection, however. The general eligibility requirements for FMLA protection that would allow someone to go to rehab under a leave of absence include:
- Having worked for your employer for at least 12 months
- Having had worked at least 1,250 hours during the previous 12 months before the start of FMLA leave
- The employer should have at least 50 employees at that location, or within 75 miles of the location
While the FMLA can help protect you against getting fired during rehab, it doesn’t mean that you will get paid while you are away. This is something you will have to consider when choosing an addiction treatment center. Some employers might pay you, but chances are more likely that they won’t. You will still be able to maintain your health insurance benefits in most cases though.
If you aren’t covered by the FMLA, it’s a good idea to let your employer know as soon as possible that you are planning to go to treatment, although you don’t necessarily have to be specific about why. The better your employer can plan for your absence, the more flexible they are likely to be.
How Can You Choose an Addiction Treatment Center?
Choosing the right addiction treatment center for you and your specific needs is very important. Choosing the right center can mean the difference between being engaged in treatment or leaving treatment early.
The following are some things that can help guide the decision-making process:
- What specific treatment approach or approaches are used at the center? For example, does the treatment center use evidence-based therapy? Are medications used or only behavioral therapies? These are all questions you can learn about when you speak to the admissions representatives at the treatment center you’re considering attending.
- Is the rehab center in-network with your insurance? What out-of-pocket expenses will you likely be responsible for paying?
- What do other people say about the treatment center? For example, what do reviews online and on social media say?
- Do you require any level of specialized treatment? For example, do you need a center that specializes in specific mental health disorders or something like chronic pain? Do you prefer a religiously-centered rehab center or a center that specializes in certain populations of people?
- What’s it like after someone leaves treatment? What level of support and aftercare planning are provided?
To learn more about addiction treatment and rehab, we encourage you to look at our independent resources highlighting rehab centers, drug information and information for families and loved ones of people with an addiction.