Drug Treatment Programs: Options and Types of Treatment

Types of Drug Treatment Programs

When excessive drug use causes health, work, home, and school problems, it’s referred to as a substance use disorder (SUD). An alcohol use disorder (AUD) is when the SUD involves only alcohol. 

These are the primary substances that can lead to substance-related disorders:¹

• Alcohol
• Opioids
• Cannabis
• Cocaine and other stimulants
• LSD and other hallucinogens
• Sedatives, hypnotics, or anxiolytics
• Inhalants
• Caffeine (no ‘addiction’ treatment available, but it can cause withdrawal symptoms) 
• Tobacco
• Other or unknown substances

A person must meet two or more of 11 criteria to be diagnosed with SUD or AUD. The severity will be classified as mild, moderate, or severe based on the number of met criteria.

Addiction can be treated, but it’s not always easy. People can’t just quit drugs or alcohol then say they’re fully recovered. 

Treatment for SUD and AUD occurs at varying levels of care. No single treatment is suitable for everyone. Addiction treatments must be tailored to individual needs.²

Treatment Options

Addiction treatment should help a person achieve the following:³

• Stop using drugs or alcohol
• Develop a substance-free state
• Be productive at home, work, and in society 

Detoxification

Addiction to most substances changes body functions. It requires time to return to the pre-addiction state.^{2, 4, 5}

Detox is the process of flushing drugs and alcohol from the body and returning it to a normally-functioning condition. 

A person may experience withdrawal symptoms during detox. These symptoms can be uncomfortable and sometimes dangerous without professional monitoring. Medical professionals can help the person endure the process safely 

Detox is often managed with medications in an inpatient or outpatient setting. This process is referred to as medically managed withdrawal. 

Benzodiazepines and anticonvulsants, for example, are commonly used to reduce alcohol withdrawal symptoms and prevent seizures.⁴

Detox is only the first step. It doesn’t address the psychological, social, and behavioral problems associated with addiction. Inpatient or other addiction treatments should follow it.

Inpatient Treatment

Inpatient or residential treatment requires people to live in the treatment facility. This is usually for those with severe addiction or those who require 24-7 care.^{2, 6} 

The types of residential treatment are:^{2, 3}

• Therapeutic communities (TC): People reside in the facility for 6 to 12 months. Both staff and residents are vital agents in changing residents' attitudes, understanding, and behaviors.
• Shorter-term residential treatment: This option has a shorter duration but is more intensive. It starts with 3 to 6 weeks of detox followed by a modified 12-step program. 
• Recovery housing: Supervised, short-term housing that follows inpatient treatment. It helps people make a smooth transition to independent living. 

Outpatient Treatment

Outpatient treatment is less structured than inpatient treatment. People don’t need to live in the treatment facility. They can go home after treatment. 

Outpatient treatment costs less than inpatient treatment. They suit people with less-severe addictions, as well as people with jobs and/or supportive living environments.^{2, 7}

The two types of outpatient treatments are:^{2, 6}

• Low- or moderate-intensity outpatient programs: These consist of less than 9 hours of weekly sessions for adults and less than 6 hours for adolescents. 
• Intensive outpatient programs (IOPs): These consist of weekly sessions lasting 9 hours or more for adults or 6 hours or more for adolescents. They are comparable to inpatient programs in terms of services and effectiveness.

Group counseling is a significant component of many outpatient programs. Some outpatient services are also designed to treat patients with co-occurring disorders.²

Partial Hospitalization Program (PHP)

PHPs are appropriate for people with unstable medical and psychiatric conditions. They differ from other treatments in terms of the intensity of substance abuse services.⁶ 

• Compared to intensive outpatient treatment, a PHP requires 20 hours or more of weekly sessions
• Compared to inpatient treatment, a PHP has no requirement for 24-hour care

Medication-Assisted Treatment (MAT)

Medications can be used to:^{2, 3} 

• Manage withdrawal symptoms
• Prevent relapse
• Treat co-occurring conditions
• Re-establish normal brain function
• Decrease substance cravings 

Examples of medications include:²

• Methadone and buprenorphine: These are opioid agonists that act on the same brain receptors as heroin and other opioids. They can suppress withdrawal symptoms and relieve opioid cravings. They also block the intense ‘rush’ from stronger opiates like heroin, oxycodone, and fentanyl. 
• Naltrexone: This is an opioid antagonist. It blocks opioids from attaching to brain receptors. It can also reduce alcohol cravings and prevent relapse. 
• Bupropion and varenicline: These are two FDA-approved medications for nicotine addiction. They work differently, but both help prevent relapse. 
• Acamprosate: This is an FDA-approved medication for alcohol addiction. It may reduce symptoms of long-lasting alcohol withdrawal.
• Disulfiram: This drug blocks alcohol metabolism. It causes alcohol to build up acetaldehyde in the body, rather than be metabolized further. This action can cause nausea and other very unpleasant reactions, leading people to reconsider their alcohol use.

Luxury Rehab

Luxury rehab centers provide 24-hour care and medical support like standard inpatient programs. The primary difference is the luxury rehab’s resort-like environment. 

Most luxury facilities are surrounded by nature. They are often located in or near world-class beaches, woodlands, mountains, or even deserts. 

Luxury rehab programs also have: 

• Higher staff-to-client ratios
• Enhanced privacy
• Gourmet cuisine options
• Non-traditional therapies like yoga, acupuncture, or art therapy
• Non-essential amenities like private pools and tennis courts

Luxury rehab is more expensive than standard inpatient treatments because of these features. However, there is currently no data that shows any improvement in long-term sobriety for those who attend luxury rehab compared to standard rehab programs.

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Behavioral Therapies

Behavioral therapies are among the most commonly used addiction methods. Their focus may involve one or more of the following goals:^2,3

• Modify people’s attitudes and behaviors related to substance abuse
• Address people’s motivation to change
• Build healthy life skills to resist substance abuse
• Provide incentives for abstinence
• Replace substance use with constructive and rewarding activities
• Help people stay in addiction treatment

Below are some behavioral therapies that are effective against different types of SUD:

Individual Counseling

In individual counseling, the person works one-on-one with a therapist. It’s sometimes called psychotherapy or talk therapy.⁸

One-on-one counseling focuses on:²

• Reducing or stopping drug or alcohol use
• Addressing important life areas like employment and family relations
• Developing coping strategies and tools for abstinence

The counselor may also:

• Encourage the person to join 12-step programs (90 meetings in 90 days or daily attendance for several months)
• Refer the person to additional medical, psychiatric, and employment services 

Group & Family Therapy

While individual therapy is a one-on-one interaction, group therapy involves treating a group with at least one therapist present. 

Group therapy can:

• Provide social reinforcement through peer discussion
• Promote abstinence and a substance-free lifestyle

There are also behavioral treatments based on the family system approach:^{2, 3}

• Multidimensional family therapy (MDFT): For adolescents with drug abuse problems. MDFT looks at the network of drug-related influences—the adolescent, peers, family, the community. It’s also designed to improve family functions. 
• Family behavior therapy (FBT): Great for adults and adolescents. FBT focuses on addressing substance use and co-occurring problems (like depression, family conflict, and unemployment). Therapists engage families to apply strategies taught in sessions.
• Brief strategic family therapy (BSFT): For adolescents with drug abuse problems. BSFT focuses on family interactions associated with drug abuse and co-occurring issues (like delinquency, aggression, and risky sexual behaviors). 
• Functional family therapy (FFT): Therapists view adolescents’ drug use problems as a result of the family’s dysfunctions. FFT aims to improve communication, problem-solving, conflict resolution, and parenting skills. 

Cognitive Behavioral Therapy (CBT) 

CBT was developed as relapse prevention for alcohol then later adapted for cocaine. It’s also effective against marijuana, methamphetamine, and nicotine addiction.

CBT helps people:^{2, 3}

• Anticipate situations where they’re likely to use alcohol or drugs
• Develop coping strategies to enhance self-control

Dialectical Behavioral Therapy (DBT)

Dr. Marsha M. Linehan developed DBT. “Dialectic” means investigating different opinions. In terms of DBT, this means building a life with two opposing goals: change and acceptance.⁹

DBT focuses on providing skills in four key areas:¹⁰

• Mindfulness: The ability to accept and be present in the current moment.
• Distress tolerance: Tolerating negative emotions instead of escaping them.
• Emotion regulation: Managing and changing intense emotions. 
• Interpersonal effectiveness: Assertively communicating with others while maintaining self-respect and relationships.

Rational Emotive Behavior Therapy (REBT) 

Albert Ellis developed REBT in 1955. Initially called rational therapy, it laid the foundations for CBT. 

Ellis established REBT’s three guiding principles known as the ABCs: 

• Activating Event: Identify situations that trigger negative emotions or reactions.
• Beliefs: Identify core beliefs attached to the negative emotions or responses. 
• Consequences: Identify the activating events and beliefs that led to substance abuse.

REBT encourages rational thinking that promotes healthy behavior and emotional expression. By deconstructing negative beliefs and replacing them with positive perceptions, the person can improve their life drastically.¹¹

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR therapy focuses on trauma memory. It aims to reduce symptoms and change how trauma memory is stored in the brain.

EMDR therapy is an eight-phase treatment. One phase involves eye movements. 

The therapist will identify a trauma memory and ask the person to focus on it. Then they will ask the person to track the therapist’s hand movement. 

Internal associations between memory and disturbing feelings will arise. The therapist will help the person process everything in the latter stages of EMDR therapy.¹²

Contingency Management (CM) 

Also called motivational incentives, CM uses positive reinforcement to encourage abstinence. It’s highly effective against alcohol, stimulant, opioid, marijuana, and nicotine addiction. 

CM has two types:^{2, 3}

• Voucher-based reinforcement (VBR): The person receives a voucher for every drug-free urine sample. They can exchange the voucher for items like food or movie passes.
• Prize incentives: People with negative drug tests or who attended therapy will have a chance to win prizes worth $1 to $100. 

Seeking Safety & Other Trauma-Focused Therapies

Trauma-focused treatment looks at the connection between mental health and addiction. Some people with mental health conditions, specifically post-traumatic stress disorder (PTSD), use drugs or alcohol for self-medication.  

Seeking Safety is an example of trauma-focused therapy. It aims to help people attain both physical and emotional safety from trauma and substance abuse. Its features include:¹³

• Group or individual format
• With males and females
• Outpatient, inpatient, home care, or school setting
• Incorporates 25 topics like “Asking for Help,” “Setting Boundaries in Relationships,” and “Coping with Triggers”

Motivational Interviewing (MI) / Motivational Enhancement Therapy (MET)

MI or MET helps people resolve their uncertainty about treatment. It’s effective against alcohol, marijuana, and nicotine addiction. 

This approach is more effective in motivating people to seek addiction treatment than actually changing their addictive behaviors.^{2, 3}

Holistic Therapy

Holistic therapies are non-medicinal recovery methods used alongside professional treatments. They focus on the person’s overall well-being while addressing withdrawal and other physical symptoms.

Some examples of holistic therapies include:¹⁴

• Yoga
• Tai chi
• Guided meditation
• Acupuncture
• Massage therapy
• Spiritual therapy
• Routine exercise
• Proper nutrition
• Counseling
• Art therapy

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Support Groups & Ongoing Treatment 

Most addiction treatment programs encourage people to participate in support groups during and after treatment. 

Support groups provide additional social support to help people achieve and maintain abstinence.²

Many popular support groups are based on the 12-step philosophy. Examples are:  

• Alcoholics Anonymous (AA)
• Narcotics Anonymous (NA)
• Cocaine Anonymous (CA)
• Crystal Meth Anonymous (CMA)
• Heroin Anonymous (HA)
• Marijuana Anonymous (MA)

The 12-step philosophy views addiction as a disease that can be stopped but not eliminated. Self-help groups have 12 “steps” or activities that people must complete during recovery.¹⁵

Alcoholics Anonymous (AA)

AA is a popular 12-step program. It’s made up of men and women who currently have a desire to stop drinking. 

The majority of AA members aren’t actively drinking. But they continue to attend to build mental strength and avoid drinking alcohol in the long-term. 

An AA meeting lasts from an hour to an hour and a half. It starts with a short prayer. A leader reads AA’s 12 steps and other doctrines out loud. 

Many attendees share their stories. Some receive AA chips or Sobriety Tokens to commemorate the length of time they have been sober. 

Attendees often mingle after the meeting to get to know one another. They can even exchange numbers with people who can provide needed support.

Narcotics Anonymous (NA)

NA is another 12-step program. It’s made up of recovering and active drug users. Members attend weekly meetings to help each other maintain abstinence.

Meetings may have educational speakers. Some attendees share their stories.  

Like other 12-step programs, NA operates on a set of 12 guidelines known as the “Twelve Traditions of NA.” 

Cocaine Anonymous (CA)

CA is a 12-step program formed in 1982. It’s for people seeking recovery from drug addiction. It’s modeled after AA, although the two groups are not affiliated. 

While most members have been or are addicted to cocaine, CA accepts people who desire freedom from other mind-altering substances as well.¹⁶

Marijuana Anonymous (MA)

This group is the most popular for marijuana addiction. It’s a 12-step program modeled after AA. 

However, MA isn’t available in all communities. Many people seeking support after rehab may find NA to be more accessible.

Al-Anon

Al-Anon is a 12-step program. Its Twelve Steps were adapted from AA. 

In Al-Anon, members believe that alcoholism is a family illness. It affects not only the drinkers but also the people around them. 

While AA consists of past and recovering alcoholics, Al-Anon is for their families and friends. 

Al-Anon isn’t geared towards helping alcoholics get sober. Rather, it helps those affected by alcoholics live a full and successful life.

SMART Recovery (Self-Management And Recovery Training)

SMART Recovery is a global organization that offers support to people with addiction. 

It teaches short-term and long-term coping skills. It uses the 4-Point Program:

1. Building and maintaining the motivation
2. Coping with cravings
3. Managing thoughts, feelings, and behaviors
4. Leading a balanced, positive, and healthy life

Secular Organizations for Sobriety (SOS)

SOS is a non-profit network composed of various addiction recovery groups. It utilizes mutual support to help members become sober. SOS is also known as Save Our Selves.
SOS is not religious or spiritual in nature.¹⁷ It provides a secular alternative to spiritually-based programs like AA and CA. It also doesn’t view spirituality or surrendering to a Higher Power as necessary for sobriety.

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