What is Medication-Assisted Treatment?

According to the Substance Abuse and Mental Health Services Administration (SAMSHA), Medication-assisted treatment (MAT), “including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.”

For more on MAT, see Medication Assisted Treatment Guide: Opioid Use Recovery Can Become Long-Term

Medicated-Assisted Treatment (MAT) employs a “whole-patient” approach to substance use disorder treatment, combining counseling and behavioral therapies with FDA-approved medications.

Medication-Assisted Treatment for Opioid Addiction

Three medications to treat opioid addiction are methadone, buprenorphine, and naltrexone. They are used to “treat opioid dependence and addiction to short-acting opioids such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.” Of course, in certain cases, individuals can MAT medications safely for extended periods of time. Here’s how SAMHSA describes each drug:

  • Methadone: “Methadone tricks the brain into thinking it’s still getting the abused drug. In fact, the person is not getting high from it and feels normal, so withdrawal doesn’t occur. Learn more about methadone.”
  • Buprenorphine: “Like methadone, buprenorphine suppresses and reduces cravings for the abused drug. It can come in a pill form or sublingual tablet that is placed under the tongue. Learn more about buprenorphine.”
  • Naltrexone: “Naltrexone works differently than methadone and buprenorphine in the treatment of opioid dependency. If a person using naltrexone relapses and uses the abused drug, naltrexone blocks the euphoric and sedative effects of the abused drug and prevents feelings of euphoria. Learn more about naltrexone.”

People also know about naloxone. It is a “FDA approved injectable drug used to prevent an opioid overdose.”

Medication-Assisted Treatment for Alcohol Use Disorder

According to SAMHSA: “Disulfiram, acamprosate, and naltrexone are the most common drugs used to treat alcohol use disorder. None of these drugs provide a cure for the disorder, but they are most effective in people who participate in a MAT program.” The medications that SAMHSA notes include:

  • Disulfiram: “Disulfiram is a medication that treats chronic alcoholism. It is most effective in people who have already gone through detoxification or are in the initial stage of abstinence. This drug is offered in a tablet form and is taken once a day. Disulfiram should never be taken while intoxicated and it should not be taken for at least 12 hours after drinking alcohol.”
  • Acamprosate: “Acamprosate is a medication for people in recovery who have already stopped drinking alcohol and want to avoid drinking. It works to prevent people from drinking alcohol, but it does not prevent withdrawal symptoms after people drink alcohol. It has not been shown to work in people who continue drinking alcohol, consume illicit drugs, and/or engage in prescription drug misuse and abuse. The use of acamprosate typically begins on the fifth day of abstinence, reaching full effectiveness in five to eight days.”
  • Naltrexone: “When used as a treatment for alcohol dependency, naltrexone blocks the euphoric effects and feelings of intoxication. This allows people with alcohol addiction to reduce their drinking behaviors enough to remain motivated to stay in treatment, avoid relapses, and take medications.”

Misconceptions in Medication-Assisted Treatment

SAMHSA notes several misconceptions about MAT, including the idea that all it does is swap one drug for another.

The agency writes: “Instead, these medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. MAT programs provide a safe and controlled level of medication to overcome the use of an abused opioid. And research has shown that when provided at the proper dose, medications used in MAT have no adverse effects on a person’s intelligence, mental capability, physical functioning, or employability.

“Medications used in MAT for opioid treatment can only be dispensed through a SAMHSA-certified OTP. Some of the medications used in MAT are controlled substances due to their potential for misuse. Drugs, substances, and certain chemicals used to make drugs are classified by the Drug Enforcement Administration (DEA) into five distinct categories, or schedules, depending upon a drug’s acceptable medical use and potential for misuse.”

Gender Differences in Drug Addiction

To think about Medication-Assisted Treatment, it may help to understand gender differences in drug addiction.

Men and women are very different when it comes to addiction and treatment for addiction.  Research is often geared at gender differences when it comes to drug abuse and addiction.

The National Institutes of Health reports: “Men are more likely than women to use almost all types of illicit drugs, and illicit drug use is more likely to result in emergency department visits or overdose deaths for men than for women. ‘Illicit’ refers to use of illegal drugs, including marijuana (according to federal law) and misuse of prescription drugs. For most age groups, men have higher rates of use or dependence on illicit drugs and alcohol than do women. However, women are just as likely as men to develop a substance use disorder. In addition, women may be more susceptible to craving and relapse, which are key phases of the addiction cycle.

Some recent statistics from the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention and The National Institute on Drug Abuse point out some interesting facts about men and addiction. These key facts are listed below:

  • Men are four times more likely than women to be heavy drinkers and two times as likely to be dependent upon alcohol.
  • About 5 million men report past-year misuse of drugs or alcohol.
  • Men are more likely to develop an addiction disorder and abuse more than one substance.
  • Most often, men begin using substances at an earlier age, and use them more often.
  • Men are 2.3 times more likely than women to enter treatment for their addiction, however, many men enter via the criminal justice system.
  • Men are more likely to struggle with pride and denial as well as relapse triggers such as depression and anxiety during addiction recovery.
  • Interestingly, more than half of men who struggle with addiction also have another mental illness, including depression, bipolar disorder and PSTD.
  • Men are almost 4 times more likely to commit suicide while drinking.
  • Men are nine times more likely to die of an alcohol-associated heart disease.
  • Men are more at risk than women to drink alcohol excessively and are therefore more likely to take other risks (for example: reckless driving, or driving without a seat belt). These risks further increase the possibility of injury or death.

When considering MAT, one might want to consider this NIH note: “Research has shown that women often use drugs differently, respond to drugs differently, and can have unique obstacles to effective treatment as simple as not being able to find child care or being prescribed treatment that has not been adequately tested on women.”

Many individuals struggling with alcohol addiction decide to do an outpatient program (instead of a live-in inpatient treatment) to aid in their recovery. Although length and intensity can vary depending upon each individuals needs, many points of treatment remain the same.

Most outpatient treatment programs geared specifically for alcohol addiction include:

  • An expectation of abstinence from alcohol
  • An initial assessment to determine the needs of the client
  • Seminars and activities for alcohol treatment that the client is expected to attend in order to educate themselves about the science of addiction.
  • Goal setting and formation of an outpatient alcohol treatment plan while discussing one’s emotions and underlying conditions (such as depression or anxiety)
  • Rules about individual’s behavior while they attend outpatient treatment for alcohol abuse.  Breaking rules often means individuals are ejected from the outpatient program
  • A certain number of therapy session each week will be agreed upon
  • Clients are generally asked to divulge personal information in individual or group settings in regards to alcohol and themselves with other clients

Connections: Alcohol and Drug Dependence

As we’ve reported, people who either suffer from substance abuse issues or may be prone to them may find a connection between alcohol and drug dependence.

According to the National Institute on Alcohol and Alcoholism, a division of the U.S. National Institutes of Health, “Alcohol and drug dependence often go hand in hand; research shows that people who are dependent on alcohol are much more likely than the general population to use drugs, and people with drug dependence are much more likely than the general population to drink alcohol.”

Indeed, the NIH statistics are eye-opening:

  • 15.3 million adults meet the criteria for an alcohol use disorder*
  • Of those, 2.3 million adults meet the criteria for a drug use disorder*

Outpatient Alcohol Addiction Treatment: Pros & Cons

There are pros and cons when deciding between inpatient and outpatient treatment programs for alcohol addiction. And just as with most outpatient programs, outpatient alcohol treatment requires work to bring forth progress. However, if clients are ready and willing to work hard, the self examination and results of outpatient treatment for alcohol can be very rewarding and extremely life changing.

An intensive outpatient rehab program exists for one purpose:To help you get your life together without leaving it. A proper approach teaches individuals how to achieve and maintain long-term sobriety through essential coping skills, while still giving enough time to take care of responsibilities at home.

Participants learn these essential coping skills from a team of addiction treatment experts.

According to the Hazelden Betty Ford Foundation: “Addiction to alcohol or other drugs is considered a spectrum disorder, meaning the condition can be classified as mild, moderate or severe. Outpatient rehab programs work best for those with mild or moderate substance abuse symptoms. An inpatient program is a better fit for individuals on the more severe end of the spectrum as well as those with co-occurring disorders such as depression, anxiety or trauma.”

“Different levels of outpatient rehab are available so that you can transition progressively from more frequent and intensive therapy to less intensive therapy as you show an ability to manage your own recovery with less clinical support.”

One challenge to being in the general population, of course, can be understanding some of signals around drinking too much.

We’ve noted an immediate effect: alcohol acts as a depressant that can lower mood and trigger depressive feelings. “The inability of the body to fully process this much alcohol in the blood leads to far more than just intoxication. Binge drinking causes dizziness, loss of motor coordination, nausea, vomiting and diarrhea, and loss of consciousness,” Alcohol.org, an American Addiction Center Resource site explains.

Alcohol’s effects over the long run on the nervous system can cause anxiety, agitation and further depression and extreme discomfort, often known as the “hangover” feeling. Sometimes, the effects become so uncomfortable, people turn to drinking again to temporarily alleviate the unpleasant symptoms. Ultimately, it can become a vicious cycle that can lead to serious addiction.

Alcohol Use Disorder

Medical News Today notes that “according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), 11 criteria help a professional decide if someone has an AUD [Alcohol Use Disorder]. If the person meets two of these criteria during a 12-month period, a doctor will consider they have the condition.”

Now a new study published in the journal Alcohol and Alcoholism identifies 5 types of alcohol use disorder that vary with age. The study is titled “Dynamic Features of Problematic Drinking: Alcohol Use Disorder Latent Classes Across Ages 18–64.”

The authors state: “Alcohol use disorders (AUDs) are linked with numerous severe detrimental outcomes. Evidence suggests that there is a typology of individuals with an AUD based on the symptoms they report. Scant research has identified how these groups may vary in prevalence by age, which could highlight aspects of problematic drinking behavior that are particularly salient at different ages. Our study aimed to (a) identify latent classes of drinkers with AUD that differ based on symptoms of AUD and (b) examine prevalences of latent classes by age.’

As Medical News Today notes, the study adds “even more nuance to the issue of problematic drinking.” The profiles, as the post outlines, can be useful for individuals who are considering treatment to understand. They include:

  • “‘Alcohol-induced injury’ characterized 25 percent of the participants. People with this profile engaged in risky behavior and got into dangerous situations that might have caused injury.”
  • “Highly problematic, low perceived life interference’ characterized 21 percent of the participants. This group said that their alcohol consumption did not have any adverse effect on their lives and did not affect their family, work, or social obligations, despite also reporting that they experienced many AUD symptoms.”
  • “The ‘Adverse effects only’ profile included 34 percent of the participants, who reported hangovers or alcohol withdrawal symptoms.”
  • “‘Difficulty cutting back’ was a profile prevalent among 13 percent of the participants. People in this category struggled or were unable to cut back on their drinking.”
  • “Highly problematic’ was the final category, which made up 7 percent of the total number of participants who had every symptom of AUD.”

Outpatient Rehab: What to Learn

As we highlight, among the topics individuals in intensive outpatient rehab will learn include:

  • Drug and Alcohol Relapse Prevention
  • Life Skills
  • How to Recognize, Confront and Handle Triggers
  • Health and Nutritional Study
  • Family and Relationship Education
  • Continuing Care
  • Anger Management/Domestic Violence
  • Relaxation and Meditation Skills
  • Phases of Recovery

See a fuller list here.

With the rise of vaping among teenagers and the concern of addiction at such a young vulnerable age, another vice has presented itself to the teenage market: juuling.

Juuling is a lot like vaping in that it’s like an e-cigarette with a pleasant odor and minimal amounts of vapor.  Fun flavors, such as fruity flavors or bubblegum flavors, are available and are especially enticing to younger individuals.  A major cause for concern, however, is the amount of nicotine the juuling devices contain and the way the substance is packaged.

For instance, among high school and college students, the use of juuling is very much on the rise.  This is due in part to the fact that students can hide the device used in the process very easily since it looks very much like a flash drive.  In fact, the device is plugged in to a USB port to charge.  So, in essence, teachers and others are struggling to identify if kids are using the products.  Further complicating the issue is that the exhaled vapor cloud is very easily hidden in a shirt sleeve.  Some campuses have banned flash drives in a effort to stop the use of the devices.

Also, the amount of nicotine in a device used for gulling is about equivalent to an entire pack of cigarettes.  With teenage brains still in the development process, the amount of nicotine inhaled creates a haven for addiction.  Most kids find they don’t even feel the effects of a single juuling session after not too long and need to do juuling more and more often. Marketers indicate they are not targeting teens, but the devices are definitely appealing to that age range.

Juuling and Teens: Fact Sheet

The American Academy of Family Physicians (AAFP) issued a Fact Sheet on juuling: “JUUL works similar to other e-cigarette devices, but has several features that make it different and potentially more dangerous. Features that distinguish JUUL from other e-cigarettes include:”

  • “JUUL resembles a USB drive. It can be concealed as a USB drive and used in public spaces, such as schools. It is charged in the USB port of a computer or laptop.”
  • “The liquid in JUUL pods contain nicotine salts from tobacco leaves. The nicotine salts are absorbed into the body at almost the same rate as nicotine from a combustible cigarette. Inhaling vapor from nicotine salts goes down smoothly and doesn’t produce the irritating feeling in the chest and lungs that combustible cigarettes do.”
  • “JUUL has more than twice the amount of nicotine concentrate as many other brands of e-cigarettes. This has raised concerns that it may have a higher risk of addiction than other e-cigarettes. One cartridge, called a pod, has roughly the equivalent amount of nicotine as one pack of cigarettes.”

Juuling and Teens: How Big is the Problem?

The U.S. Centers for Disease Control released a powerful report: Reasons for Electronic Cigarette Use Among Middle and High School Students. It helps explain how big the problem is.

Among the findings:

  • Electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among U.S. middle school and high school students in 2016.
  • CDC and the Food and Drug Administration (FDA) analyzed data from the 2016 National Youth Tobacco Survey (NYTS) to assess self-reported reasons for e-cigarette use among U.S. middle school (grades 6–8) and high school (grades 9–12) student e-cigarette users.
  • Among students who reported ever using e-cigarettes in 2016, the most commonly selected reasons for use were 1) use by “friend or family member” (39.0%); 2) availability of “flavors such as mint, candy, fruit, or chocolate” (31.0%); and 3) the belief that “they are less harmful than other forms of tobacco such as cigarettes” (17.1%).
  • The least commonly selected reasons were 1) “they are easier to get than other tobacco products, such as cigarettes” (4.8%); 2) “they cost less than other tobacco products such as cigarettes” (3.2%); and 3) “famous people on TV or in movies use them” (1.5%). Availability of flavors as a reason for use was more commonly selected by high school users (32.3%) than by middle school users (26.8%).
  • Efforts to prevent middle school and high school students from initiating the use of any tobacco product, including e-cigarettes, are important to reduce tobacco product use among U.S. youths.

Juuling and Teens: Public Health Concern

The CDC further concludes that juuling is a public health concern, noting that:

  • The U.S. Surgeon General has concluded that e-cigarette use among youths and young adults is a public health concern. The prevalence of e-cigarette use among youths increased substantially during 2011–2015.
  • In 2016, e-cigarettes were the most common tobacco product used among adolescents, although the overall prevalence of use declined from previous years. The Surgeon General has also concluded that e-cigarettes can contain harmful and potentially harmful constituents, including nicotine; exposure to nicotine during adolescence can cause addiction and can harm the developing adolescent brain.
  • Recent research indicated that e-cigarette use declined among adolescent students in 2016, likely in part because of population-based efforts to prevent youths’ e-cigarette initiation and use. Continued efforts are important to further reduce all forms of tobacco product use, including e-cigarettes, among U.S. youths.
  • As noted by the Surgeon General, population-level strategies include incorporating e-cigarettes into smoke-free indoor air policies, restricting youths’ access to e-cigarettes in retail settings, licensing retailers, and establishing specific package requirements.

What Parents Need to Know About Juuling and Teens

According to the Cleveland Clinic: “Juul is a sleek, black vaping pen that fits in the palm of your hand. Like other top-selling e-cigarettes on the market (including Vuse, Logic, Blu and MarkTen), it comes with little cartridges of “juice” that contain nicotine, fruity flavorings and other chemicals. The cartridges snap into the device, and the juice is heated up when a user inhales, creating a vapor that delivers a quick hit of nicotine — and the pleasant sensation that smoking cigarettes creates, explains pulmonologist Humberto Choi, MD.”

It continues: “But unlike other kinds of e-cigarettes, Juul and the newest class of devices are discreet enough that teenagers are using them in school bathrooms, hallways and even classrooms. They’re small and easy to hide, and the fruity smelling smoke dissipates quickly. Not only has “juuling” become so popular that it’s now a verb, but it’s even inspired a series of social media hashtags.”

More education about the dangers of vaping, smoking, and juuling needs to be presented to the teens and young people in our schools.  Hopefully this type of prevention education, along with parent and teacher awareness, can put an end to juuling among teens.

The CDC notes that further action is needed:

  • Comprehensive strategies to prevent and reduce the use of all tobacco products, including e-cigarettes, among U.S. youths are warranted.
  • Regulation of the manufacturing, distribution, and marketing of tobacco products by FDA, along with sustained implementation of comprehensive tobacco control and prevention strategies, could reduce youths’ e-cigarette initiation and use.
  • In addition, continued monitoring of e-cigarette use, including reasons for use and product characteristics, is important to guide strategies to prevent and reduce use of e-cigarettes among youths.

Sadly, ecstasy is one of the most popular used drugs —especially among youth —today.  In fact, it is estimated that there are 9 million ecstasy users worldwide.  Although ecstasy is illegal, the young adults and teens who most often use the drug don’t recognize just how dangerous it is. Mixed with alcohol, ecstasy becomes even more dangerous and can be deadly.

This Guide outlines:

  • What is Ecstasy?
  • How Ecstasy Affects the Brain
  • Added Risk of MDMA
  • Is Ecstasy Addictive?
  • Video: Your Brain on MDMA

What Is Ecstasy?

What exactly is ecstasy?  The National Institute of Drug Abuse defines ecstasy as: “a synthetic drug that alters mood and perception (awareness of surrounding objects and conditions). It is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception.”

It continues: “MDMA was initially popular in the nightclub scene and at all-night dance parties (“raves”), but the drug now affects a broader range of people who more commonly call the drug Ecstasy or Molly.”

It adds: “MDMA’s effects last about 3 to 6 hours, although many users take a second dose as the effects of the first dose begin to fade. Over the course of the week following moderate use of the drug, a person may experience:”

  • irritability
  • impulsiveness and aggression
  • depression
  • sleep problems
  • anxiety
  • memory and attention problems
  • decreased appetite
  • decreased interest in and pleasure from sex

How Ecstasy Affects the Brain

According to the NIH, MDMA increases the activity of three brain chemicals:

  • Dopamine—produces increased energy/activity and acts in the reward system to reinforce behaviors
  • Norepinephrine—increases heart rate and blood pressure, which are particularly risky for people with heart and blood vessel problems
  • Serotonin—affects mood, appetite, sleep, and other functions. It also triggers hormones that affect sexual arousal and trust. The release of large amounts of serotonin likely causes the emotional closeness, elevated mood, and empathy felt by those who use MDMA.

Further health effects include:

  • nausea
  • muscle cramping
  • involuntary teeth clenching
  • blurred vision
  • chills
  • sweating

Added Risk of MDMA

Adding to MDMA’s risks is that pills, capsules, or powders sold as Ecstasy and supposedly “pure” Molly may contain other drugs instead of or in addition to MDMA. Much of the Molly seized by the police contains additives such as cocaine, ketamine, methamphetamine, over-the-counter cough medicine, or synthetic cathinones (“bath salts”). These substances may be extremely dangerous if the person does not know what he or she is taking. They may also be dangerous when combined with MDMA. People who purposely or unknowingly combine such a mixture with other substances, such as marijuana and alcohol, may be putting themselves at even higher risk for harmful health effects.

There are other side effects. High doses of MDMA can affect the body’s ability to regulate temperature. This can lead to a spike in body temperature that can occasionally result in liver, kidney, or heart failure or even death.

In addition, because MDMA can promote trust and closeness, its use—especially combined with sildenafil (Viagra®)—may encourage unsafe sexual behavior. This increases people’s risk of contracting or transmitting HIV/AIDS or hepatitis.

Is Ecstasy Addictive?

“The NIH reports: Research hasn’t definitively answered whether MDMA is addictive, although it affects many of the same neurotransmitter systems in the brain that are targeted by other addictive drugs. Experiments have shown that animals will self-administer MDMA—an important indicator of a drug’s addictive potential—although the degree of self-administration is less than some other addictive drugs, such as cocaine.”

“Data from both humans and animals suggest that regular MDMA use produces adaptations in the serotonin and dopamine systems that are associated with substance use disorder and related behaviors, such as increased impulsivity. Few studies have attempted to assess MDMA addiction or dependency among people with a history of use in the general population. Studies that have been conducted have shown widely varying results, likely because of the different population samples and different types of measures used. Some people who use MDMA do report symptoms of addiction, including continued use despite negative physical or psychological consequences, tolerance, withdrawal, and craving.”

Still, as the NIH reports elsewhere: “Yes, you can die from MDMA use. MDMA can cause problems with the body’s ability to control temperature, especially when it is used in active, hot settings (like dance parties or concerts). On rare occasions, this can lead to a sharp rise in body temperature (known as hyperthermia), which can cause liver, kidney, or heart failure or even death.”

Additional insights come from the UK. The Guardian reports: “More people are taking ecstasy than ever before – and more people are dying from it. According to the Office for National Statistics (ONS), about one in 20 16- to 24-year-olds report having taken ecstasy in the past 12 months; the Global Drugs Survey (GDS) found an increase in use among UK clubbers of 16% between 2014 and 2016.”

The report continues: “According to figures released by the ONS towards the end of 2016, deaths linked to ecstasy or MDMA are at their highest level in a decade. In 2010, there were eight; in 2015, the count was 57. According to last year’s Global Drugs Survey, in which more than 100,000 drug users worldwide were quizzed about their habits, this is ‘the worst time to be using MDMA in a generation.'”

Video: Your Brain on MDMA

According to Eric Chudler, Ph.D. a neuroscientistand Executive Director of the Center for Sensorimotor Neural Engineering: “Data suggest that MDMA may be toxic to the brain. Dr. George Ricaurte, an associate professor of neurology at Johns Hopkins University, analyzed brain scans of people who had used ecstasy. The study included people who had used ecstasy an average of 200 times over five years. Although the behavior of these people appeared normal, brain scans showed that the drug had damaged their brains. In fact, those who used the drug more often had more brain damage than less frequent users. Moreover, memory tests of people who have taken ecstasy as compared to non-drug users have shown that the ecstasy users had lower scores.”

He continues: “Specifically, the drug damaged cells that release the neurotransmitter called serotonin. Using an imaging technique called positron emission tomography (PET), Ricaurte noted a 20-60% reduction in healthy serotonin cells in the drug users. Damage to these cells could affect a person’s abilities to remember and to learn.”

What does MDMA actually do to your brain? ASAPScience explains:

More and more service animals—specifically dogs— are being spotted everywhere we go.  Service animals are very useful in helping individuals with the various things they struggle with.  Service dogs or service animals are defined by the Americans with Disabilities Act (ADA) as “dogs (or other animal species) that are individually trained to do work or perform tasks for a person with a disability.” The disabilities stated include blindness, deafness, loss of limb and paralysis, as well as physical diseases such as epilepsy and diabetes. Further, service animals called “emotional support animals” can help with emotional illnesses such as anxiety and can comfort those with emotional or mental illnesses.

The ADA National Network defines a service animal as “Any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, trained or untrained, are not considered service animals.”

“The work or tasks performed by a service animal must be directly related to the individual’s disability. Examples of work or tasks include, but are not limited to:”

  • Assisting individuals who are blind or have low vision with navigation and other tasks.
  • Alerting individuals who are deaf or hard of hearing to the presence of people or sounds.
  • Providing non-violent protection or rescue work.
  • Pulling a wheelchair.
  • Assisting an individual during a seizure.
  • Alerting individuals to the presence of allergens.
  • Retrieving items such as medicine or the telephone.
  • Providing physical support and assistance with balance and stability to individuals with mobility disabilities.
  • Helping individuals with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors.

Specifically, service animals are trained to do the things in certain aspects of life that a disabled person can’t. For instance, these animals can get clothes, open doors, navigate routes, etc.  Even more amazing is the animals that help individuals deal with seizures, anxiety, diabetes, or even OCD (obsessive compulsive disorder).  These animals are trained to know and sense the beginning of a medical episode and warn individuals so they can take measure to prevent or lessen what is about to happen.  Having a service animal can reduce stress, soothe individuals, and for many individuals-having a service animal can give emotional support.

Service Animals and Recovery

Studies are showing more and more that service animals could positively impact those delaying with addiction recovery.  This good news shows that the soothing impact of an animal companion can stop triggers, can sense oncoming anxiety attacks, and many more things to benefit those in recovery.

Many service animals help addicts make it through recovery one day at a time.  Taking care of someone else needs is also good for those in recovery and feeling unconditionally loved gives them an immense amount of support in return.  The reciprocal relationship of having an animal that is helping to take care of an addict while the addict takes care of the animal is shown to be very beneficial.  Service animals don’t judge based on a person’s past and are more than happy to forge a new future together with those they are helping through recovery.  Many find that having a service animal is the final piece that gives them purpose as well as hope during their addiction recovery.

Opioid addiction treatment is being taken seriously. Recent findings have led to an increase in availability of opioid treatment centers and strengthened research on how this kind of substance abuse can be treated to save countless lives and curtail the gateway from prescription opioids, like oxycodone, to synthetic opioids like heroin.

(For more information, see “The Opioid Epidemic: Role for Substance Abuse Programs)

This year, the White House declared opioid addiction to be a public health emergency. The announcement was based on devastating numbers surrounding Americans and opioid use: According to 2017 data, 11.4 million Americans have misused prescription opioids; 2.1 million Americans have an opioid abuse disorder; and 130 people die every day from opioid-related drug overdose.

The alarming numbers surrounding opioid misuse have provided an opportunity for Americans to take a harder look at the realities of addiction. In response to the opioid crisis, the U.S. Department of Health and Human Services set five priorities:

  1. Improve access to treatment and recovery services
  2. Promote the use of overdose-reversing medications
  3. Strengthen public health awareness of communities at-risk or facing opioid addiction
  4. Provide support for more research on addiction
  5. Advance practices for pain management, as pain is often a  reason for individuals to begin misusing opioids.

Opioid Addiction Treatment: Approaches

But what makes opioid addiction so urgent to address is the gripping nature of the addiction.

Opioids are a class of drugs that act in the nervous system to produce feelings of pleasure and pain relief,” the Genetics Home Reference, a government site dedicated to expanding knowledge on genetic conditions. “Opioid addiction is characterized by a powerful, compulsive urge to use opioid drugs, even when they are no longer required medically. Opioids have a high potential for causing addiction in some people, even when the medications are prescribed appropriately and taken as directed. Many prescription opioids are misused or diverted to others. Individuals who become addicted may prioritize getting and using these drugs over other activities in their lives, often negatively impacting their professional and personal relationships. It is unknown why some people are more likely to become addicted than others.”

Because of the lack of existing knowledge as to why some people become more dependent than others on opioids, and the high-risks of the addiction, treatment is carefully tailored depending on specific misuse. Treatment can involve many aspects of other personalized addiction recovery, such as outpatient support, counseling, behavioral therapy and sobriety. But in addition, the case for pharmacological treatment has become increasingly recommended and helpful for those battling addiction.

Depending on the severity of the addiction and the opioid at misuse, medications such as methadone, buprenorphine and naltrexone may be administered to combat the physical grippings of opioid addiction. Methadone treatment has actually increased more in the past four years nationwide than it has in the past decade, as it has proven success on many counts.

Best practice states that tailored treatment geared towards the individual’s specific circumstances, physical and mental state and depth of addiction is the most successful. Having a personalized recovery plan, with help from professionals, can help keep addiction at bay.


We recently addressed the question “what is outpatient drug rehab?” But a follow-up question often is: What comes after?

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) offers a useful rundown — what it calls a “Roadmap to Recovery.”

SAMHSA states: “Recovery from a substance use disorder is not a mysterious process. After the use of substances is stopped, the brain goes through a biological readjustment. This readjustment process is essentially a ‘healing’ of the chemical changes that were produced in the brain by substance use. It is important for people in the beginning stages of recovery to understand why they may experience some physical and emotional difficulties. The durations of the stages listed below are a rough guide of recovery, not a schedule. The length of stages will vary from person to person. The substance used will affect the client’s progress through the stages, too. Clients who had been using methamphetamine will tend to spend more time in each stage than clients who were using cocaine or other stimulants.”

But challenges exist to recovery. SAMHSA outlines them:

1) Friends and associates who use: You want to continue associations with old friends or friends who use. You can:

  • Participate in new activities or hobbies that will increase your chances of meeting abstinent people
  • Plan activities with abstinent friends or family members

2) Anger, irritability: Small events can create feelings of anger that seem to preoccupy your thoughts and can lead to relapse. You can:

  • Remind yourself that recovery involves a healing of brain chemistry. Strong, unpredictable emotions are a natural part of recovery
  • Engage in exercise
  • Talk to a counselor or a supportive friend

3) Substances in the home: You have decided to stop using, but others in your house may still be using. You can:

  • Get rid of all drugs and alcohol
  • Ask others to refrain from using and drinking at home
  • If you continue to have a problem, think about moving out for a while

4) Boredom, loneliness: Stopping substance use often means that activities you did for fun and the people with whom you did them must be avoided. You can:

  • Put new activities in your schedule
  • Go back to activities you enjoyed before your addiction took over
  • Develop new friends at 12-Step or mutual-help meetings

5) Special occasions: Parties, dinners, business meetings, and holidays without substance use can be difficult. You can:

  • Have a plan for answering questions about not using substances
  • Start your own abstinent celebrations and traditions
  • Have your own transportation to and from events
  • Leave if you get uncomfortable or start feeling deprived

Of course, these challenges can seem overwhelming. But help is there for you, In fact, one of the benefits of an intensive outpatient drug rehab program is to prepare you for these types of issues. Among the things you’ll learn:

  • Drug and Alcohol Relapse Prevention
  • Life Skills
  • How to Recognize, Confront and Handle Triggers
  • Health and Nutritional Study
  • Family and Relationship Education
  • Continuing Care

For a longer list, check out a fuller explanation here.

For people suffering from substance abuse, one of the key considerations for seeking help is outpatient drug rehab. But what is it exactly?

At the simplest level, outpatient drug rehab means you don’t live at the center. Instead, you attend sessions, which could be individual, group, or a combination of the two.

A key is to understand one’s own behavior. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) notes: “People who abuse substances often feel that their lives are out of control. Maintaining control becomes harder and harder the longer they have been abusing substances. People do desperate things to continue to appear normal. These desperate behaviors are called addictive behaviors—behaviors related to substance use. Sometimes these addictive behaviors occur only when people are using or moving toward using. Recognize when you begin to engage in these behaviors. That’s when you know to start fighting extra hard to move away from relapse.”

Outpatient Drug Rehab: Goal

But the goal of outpatient drug rehab is to help you get your life together without leaving it. We teach you how to achieve and maintain long-term sobriety through essential coping skills, while still giving you enough time to take care of your responsibilities at home.

Indeed, the Hazelden Betty Ford Foundation notes: “Outpatient treatment for substance abuse can be an ideal option if you have the motivation to get sober but can’t take leave from work, disrupt school attendance or step away from other responsibilities in order to stay at an inpatient rehab center. But the most effective treatment—whether a residential program or outpatient drug rehab—really depends on the severity of your substance abuse and whether you’re also experiencing related medical or mental health complications.”

“Recovery is a lifelong process.”

U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)

Intensive outpatient drug rehab often includes group therapy. SAMHSA recommends: “The more work you put into group therapy, the more benefit you will receive from it. Part of the work you should be doing is reading and thinking about the handouts. But there are other things you can do to make sure you benefit fully from group therapy.” The list includes:

  • Attend every group session.
  • Arrive for group sessions on time or a little early.
  • Listen carefully and respectfully to the counselor and the other clients.
  • Be supportive of other clients. If you disagree with someone, be polite when you speak to him or her. Do not attack people personally.
  • Do not talk about other clients’ personal information outside group. Clients must be able to trust one another if they are to feel comfortable sharing their thoughts.
  • Think about what you read and about what the counselor and other clients say.
  • Ask questions when you do not understand something.
  • Participate in group discussions.
  • Do not dominate the conversation. Allow time for other clients to participate.
  • Be honest.
  • After the session is over, think about what you learned and try to apply it to your recovery.
  • Work on the homework assignments that the counselor gives you. (The homework assignments are usually an activity. These are different from the handouts that you work on during the session.)

Of course, the effort to make sure outpatient drug rehab works continues even after the program ends.

SAMHSA adds: “Recovery is a lifelong process. You can stop drug and alcohol use and begin a new lifestyle during the first 4 months of treat- ment. Developing an awareness of what anchors your recovery is an important part of that process. But this is only the beginning of your recovery. As you move forward with your recovery after treatment, you will need a lot of support. And you may need different kinds of support than you did during treatment.”


Among the many dangers of the opioid epidemic are the overdose risks. The key, of course, is to help addicts not only understand the benefits of substance abuse programs, but also to find the strength to take advantage of the opportunities they present.

As we note: “Long-term use also of opioids can lead to physical dependence – the body adapts to the presence of the substance and withdrawal symptoms occur if use is reduced abruptly. This can also include tolerance, which means that higher doses of a medication must be taken to obtain the same initial effects. Note that physical dependence is not the same as addiction – physical dependence can occur even with appropriate long-term use of opioid and other medications. Addiction, as noted earlier, is defined as compulsive, often uncontrollable drug use in spite of negative consequences.”

CBS News reports: “Addiction is a disease, they’ll tell you, and the national opioid epidemic does not discriminate. With more than 115 Americans dying each day from an overdose, addicts can be found in homeless shelters, mansions or your own home.”

60 Minutes showed just how dire the situation can be for opioid addicts — and the role for Naloxone. The National Institute on Drug Abuse, which is part of the National Institutes of Health, explains what Naxalone is and how it works: “Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications.”

Click on the below 60 Minutes video to watch the report.


How do alcohol and drug dependence connect? What do people who either suffer from substance abuse issues or may be prone to them need to know?

According to the National Institute on Alcohol and Alcoholism, a division of the U.S. National Institutes of Health, “Alcohol and drug dependence often go hand in hand; research shows that people who are dependent on alcohol are much more likely than the general population to use drugs, and people with drug dependence are much more likely than the general population to drink alcohol.”

Indeed, the NIH statistics are eye-opening:

  • 15.3 million adults meet the criteria for an alcohol use disorder*
  • Of those, 2.3 million adults meet the criteria for a drug use disorder*

In addition, there is the risk for dual diagnosis issues, treatment for which, as we’ve pointed out, is high effective but rarely offered: A majority of rehabilitation treatment centers in the U.S. only treat either addiction disorders or mental health disorders, not both concurrently. In a 2014 research study published in Administration and Policy in Mental Health and Mental Health Services Research that reviewed 256 programs across the U.S., only 18% of addiction treatment programs and 9% of mental health treatment programs addressed both issues with the individual and could be classified as “Dual Diagnosis Capable.” (Note: For more information on the symptoms and populations of dual diagnosis, see our post here.)

The NIAA states that patients with both alcohol and other drug use disorders:

  • “May have more severe dependence-related problems”
  • “Are more likely to have psychiatric disorders and are more likely to attempt suicide and suffer health problems”
  • “Are at risk for dangerous interactions between the substances they use, including fatal poisonings”

The combination of alcohol and drug use is important to watch — and always a concern for individuals who suffer from substance abuse issues.

Connecting Alcohol and Drug Dependence

In an article titled “Timing of Alcohol and Other Drug Use,” Dr. Christopher Martin, associate professor of psychiatry and psychology at the Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, writes about the connection:

“Many Americans who drink alcohol are polydrug users—that is, they also use other psychoactive drugs, such as nicotine, pharmaceuticals, cannabis, and other illicit substances. Polydrug use is a general term that describes a wide variety of substance use behaviors. Different types of polydrug use can be described with regard to the timing of the ingestion of multiple substances. Concurrent polydrug use (CPU) is the use of two or more substances within a given time period, such as a month or a year. Simultaneous polydrug use (SPU) is the use of two or more substances in combination (i.e., at the same time or in temporal proximity). Thus, although all simultaneous polydrug users are, by definition, concurrent users, concurrent users may or may not be simultaneous users.”

Indeed, the research shows real dangers: “SPU can have particularly dangerous consequences because AOD combinations can have additive or interactive effects on acute intoxication and impairment. The majority of deaths attributed to heroin overdose involve significant levels of other drugs such as alcohol or benzodiazepines; opiate levels appear to be similar in both fatal and nonfatal overdoses . Similarly, about two-thirds of oxycodone-related deaths were found to involve the use of alcohol and/or other drugs. Finally, fatalities and injuries reported to be “alcohol-related” often involve other drug use.


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