The goals of treatment are, in general, to help the person to stop using substances and to regain satisfactory levels of self-reliance and quality of life
The treatment of people with addictive disorders is generally based on a combination of more or less sustained social support, individual and/or group psychological follow-up and possible drug treatment. It is said that the support is multidisciplinary and global, in order to respond as well as possible to a multi-faceted problem, as addiction is never an isolated factor in a person’s life.
Without help, it is very difficult to stop using a substance or an addictive behaviour on one’s own, which is why the people concerned must begin by meeting a professional (addictologist, tobaccologist, etc.) responsible for assessing their consumption or behaviour (management of behavioural, non substance-related addictions), as well as their level of dependence and its consequences on a personal, family and social level. The first interview or assessment interview is an important stage: it enables a precise profile to be drawn up of the person’s situation and their motivation to stop, and then to establish a protocol for withdrawal and then for treatment adapted to the case.
During the first interview, the professional assesses:
- The frequency, modalities and doses of substances used, or, in the case of an addiction without substances, the frequency of their use practices (for example, gambling). In addition, the age of initiation is determined and the possible association with other drugs and/or medication is checked.
- The consequences and risks associated with the potentially addictive use or practice at individual, family, social and professional levels.
The various treatment modalities or phases
A person’s motivation to stop their addictive disorders often has ups and downs. Adolescents, for example, are often referred to treatment services by their parents or by the courts. Their motivation is then limited and they are often in a position of denial about their addictive disorders and refusal of any form of help.
It is often said that: If the person is not motivated, or aware of their problem, we cannot help them. However, for professionals, increasing individual motivation is also an objective per se, before implementing the actual treatment. The role of the professional is to accompany the person until they realise the value of stopping their substance use or behavioural practice. Thereafter, both can define a number of objectives to be achieved in a calm atmosphere.
The detoxification phase does not deal with the psychological, social and behavioural problems related to the addiction; it is only but a small part of the treatment process
The detoxification phase concerns physically dependent users (alcohol, tobacco, opioids) and aims to alleviate the physical and psychological symptoms and discomforts associated with the cessation of use: the withdrawal syndrome.
It should be emphasised that these withdrawal support protocols only concern substance dependence; at the moment there are no drugs capable of helping with the cessation of behavioural addictions, such as compulsive gambling.
The detoxification phase consists of “cleansing” the body of all substances used up to that point. It can be carried out in a hospital or as part of a specialised treatment programme and should always be medically supervised, in order to best address the unpleasant and potentially dangerous physiological consequences of stopping certain substances. The drugs used in the treatment of withdrawal syndrome depend on the type of drug used, for example, in the case of heavy opiate dependence (excluding substitution treatment) these drugs include, depending on the symptoms, non-opiate analgesics, antispasmodics, antiemetics, antidiarrheal and anxiolytics.
A special case is withdrawal from barbiturates or benzodiazepines. These two classes of drugs are withdrawn gradually by slowly decreasing the dose. These types of drugs should never be stopped abruptly, as there is a risk of serious complications.
While short-term programmes may not always be advantageous in the case of long-standing addiction, they are generally sufficient in the treatment of patients with a lower level of addiction. In addition, many of these patients must be able to return quickly to their professional or family responsibilities and can only engage in one of these short-term programs. This is why the most motivated people can benefit from a 28-day treatment program and a post-treatment outpatient follow-up program.
Typically, 28-day treatment programmes include a medically supervised withdrawal period of 7 days, followed by a 21-day phase of intensive assessment and counselling. During this time, patients learn about the reasons for their addiction and various strategies to prevent relapse. These programs are based on cognitive and behavioural therapies.
These residential programmes are often more successful than shorter-term programmes. When a person is struggling with an addiction, it disrupts their entire life. The emotional, physical, behavioural and social consequences of addiction are profound, therefore, it is necessary to provide treatment of sufficient duration to give people the necessary support, tools and encouragement to improve their self-esteem, well-being and quality of life as a whole.
These programmes used similar strategies: after the detoxification and evaluation phase, an individual treatment plan is put in place. Subsequently, through cognitive and behavioural therapies, the person learns to modify their self-destructive thinking processes, and by analyzing the root causes of their addiction, they can find out mechanisms to cope with stress, anger, or other emotions, without having to resort to substance use or other addictive behaviours. Medium-term residential programmes last 60 to 90 days and long-term programmes last six or even up to 12 months in therapeutic communities.
Outpatient treatment programmes are usually designed for people with jobs or significant social support. Programmes may vary depending on the type and intensity of the services offered. Some low-intensity programmes focus on providing information on drugs while intensive day treatment programmes offer services comparable to those provided by residential facilities. All these programmes are adapted to the characteristics and needs of each person.
Many outpatient treatment programmes rely on group counselling activities, which are often very effective. Lastly, some outpatient programmes are also designed to address the needs of people with mental health problems in addition to substance use disorders.