Alcohol or other Drug addiction: Getting help & treatment choices.

If you’re worried about your own or a friend or family member’s alcohol or other drug use, it’s important to know that help is available. Learning about the nature of addiction—why and how it develops, what it looks like, and why it can have such a powerful hold—will give you a better understanding of the problem and how best to deal with it.

Recognising that you/we have a problem is the first step on the road to recovery, one that takes tremendous courage and strength. Facing your/our addiction without minimising the problem or making excuses can feel frightening and overwhelming, but recovery is within reach. If you’re ready to make a change and willing to seek help, you can overcome your addiction and build a satisfying, life for yourself.

There’s a wide range of addiction services that can help. Some of these services are provided by the NHS, and some are specialist drug facilities run by charities and private organisations. Everyone has the same entitlement to care as anyone else suffering with any other health problem. With the right help and support, it’s possible for you to start your recovery journey.

This section will steer you through the options, so you can find help that works for you.

Opioid dependence can refer to many different drugs. Heroine, morphine, methadone, buprenorphine, opium, codeine, tramadol are all opioid drugs and have similar effects on the mind and body. The use of any of them can lead to dependence.

Where to get help for drugs

There are 2 main ways you can choose to get into treatment – self referral or through your GP.
Self-referral – when you go straight to the treatment service to get help. Details of treatment services are available online, from your local NHS services. Find drug treatment services in England, Wales, Scotland, Northern Ireland
Through your GP – Your GP will discuss your concerns, drug use and might offer to treat you or will refer you to your local specialist drug service.

Which ever option you choose – before treatment can start, you will discuss your concerns and drug use with your GP, health professional or trained substance use disorder worker. They will assess the nature of your problems and help you choose the most appropriate treatment options available. If you are seen at your local drug treatment service, you will first be assessed. If you are deemed appropriate for treatment, you will then be allocated a keyworker.

Your personal care plan will then be developed with you. This care plan normally details your immediate and longer-term treatment goals and is intended to be updated throughout your time in treatment as your needs and circumstances change.

Your treatment journey should be tailored to your circumstances and needs however most treatment can involve some form of talking therapy and or prescribed medication.

Treatment choice

Addiction treatment can include medications, behavioral therapies, mutual aid or a combination.

Talking Therapies

What is this?

Talking therapies are when you talk about your problems. This may involve exploring the reasons for your substance use but may focus on what you can do to resist using or to achieve other positive goals, or may involve a mixture of these. These sessions can be one to one, group sessions or sessions with your partner and or family.

Access to treatment
You may access treatment through your GP, mental health professional, charities, community drug service providers and rehabs.
You can also access talking treatments through the private sector, but please make sure any therapist you consider understands substance use disorder issues.

Talking therapy treatment

Talking therapy enables you to talk to other people about your substance use issues. To identify the particular issues affecting you and work together to:

  • Explore the reasons why you have been using substances.
  • Overcome problems that date from before your substance use, or that may of caused your use to increase.
  • Look at techniques to using substances.
  • Focus on positive goals for your future.

Self-help / Mutual Aid

What is self-help / mutual aid?
At its most simple level, mutual aid can be described as people with similar experiences helping each other to manage or overcome issues. What it infers is a system where people come together with their peers to build a network of support. People help each other overcome their dependence through face to face meetings or online support groups.

Access to self help / mutal aid groups

Mutual aid is typically provided outside formal treatment agencies and is one of the most commonly travelled pathways to recovery. There are many models of mutual aid, with varying approaches and set ups for different cohorts of people. The most widespread and evidenced based are the ’12-step’ fellowships (Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Families Anonymous, Marijuana Anonymous etc), but there are also SMART Recovery Groups, Intuitive Recovery and Secular Organisations for Sobriety, to name but a few. These supportive networks span the country, at times and in places where a large number of people can access support.

You will be able to find details of your local groups through your local drug service provider.

Narcotics Anonymous (NA) have groups across the country. The UKNA helpline is on 0300 999 1212. NA is a program of complete abstinence from all drugs. There is only ONE requirement for membership, the desire to stop using. NA supports anonymity and allows addicts to attend meetings without the fear of legal or social repercussions.

In meetings members regularly share their personal experiences with each other, not as professionals but as ordinary people who have discovered that sharing brings about solutions to their problems. Narcotics Anonymous has no professional therapists, no residential facilities and no clinics. NA provides no vocational, legal, financial, psychiatric or medical services.

SMART Recovery is an addiction recovery support group. SMART Recovery supports individuals who have chosen to abstain, or are considering abstinence from any type of addictive behaviors (substances or activities), by teaching how to change self-defeating thinking, emotions, and actions; and to work towards long-term satisfactions and quality of life.

SMART Recovery:

  • Teaches self-empowerment and self-reliance.
  • Encourages individuals to recover and live satisfying lives.
  • Teaches tools and techniques for self-directed change.
    • Coping with urges
    • Enhancing and maintaining motivation to abstain
    • Problem solving – managing thoughts, feelings and behaviours
    • Lifestyle balance
  • Meetings are educational and include open discussions.
  • Advocates the appropriate use of prescribed medications and psychological treatments.
  • Evolves as scientific knowledge of addiction recovery evolves.

Some people’s journey to recovery takes them straight to mutual aid; for others, their journey goes via the ‘formal’ structured treatment system or doctors, nurses and counsellors. Either way, mutual aid groups provide an immense opportunity to offer the kind of supportive environment needed to help individuals recover and to support them in the long term – as well as giving them the opportunity to support others.

Inpatient Rehabilitation

What is rehab?

Inpatient rehabs are intensive, residential treatment programs designed to treat serious addictions. Patients stay at a clinic in a controlled environment with 24-hour medical and emotional support. During inpatient treatment, residents are able to completely focus on getting well and sober without the distractions of everyday life.

Residential treatment facilities may use a variety of therapeutic approaches, and they are generally aimed at helping the patient live a drug-free, crime-free lifestyle after treatment. Psychologists, counselors and psychiatrists meet with patients individually and in group settings to guide inpatient recovery. A typical inpatient program runs anywhere from 28 days to six months.

The first step in inpatient treatment is medically assisted detox as well as intensive counseling and preparation for treatment in a community based setting. Physicians and addiction specialists monitor patients’ vital signs while the drugs exit the system. Drug cravings are common during detox and can be difficult to overcome, often leading to relapse.

Constant medical care provided during inpatient treatment helps guard against relapse. Clinicians can provide necessary medicine and medical expertise to lessen cravings and withdrawals.

Rehab Watch has been set up by the NHS in England and Wales so that you can highlight any difficulties that you have experienced in accessing rehab.

Outpatient Treatment

Outpatient drug rehab is less restrictive than inpatient programs and allows recovering addicts to remain at home during treatment. Those undergoing outpatient drug rehab can continue working and remain close to family and friends. These sessions focus on substance use disorder education, individual and group counselling, and teaching addicted people how to cope without their drug. They typically offer forms of behavioral therapy such as:

  • Cognitive-behavioral therapy, which helps patients recognise, avoid, and cope with the situations in which they are most likely to use drugs
  • Family therapy—developed for adolescents with Substance use disorder problems as well as their families—which addresses a range of influences on their Substance use disorder patterns and is designed to improve overall family functioning
  • Motivational interviewing, which makes the most of people’s readiness to change their behavior and enter treatment
  • Motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs

Outpatient drug rehab can be a good standalone option for someone with a mild addiction, or it can be part of a long-term treatment program. Twelve step groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) may be used as part of outpatient treatment.

Many recovering people also turn to outpatient treatment after completing an inpatient program as part of their continued recovery

Medicated Assisted Treatments

If you are addicted, medication can sometimes allow you to regain a normal state of mind, free of drug-induced highs and lows.  It can help reduce problems of withdrawal and craving. These changes can give you the chance you need to focus on the lifestyle changes that lead back to healthy living.

Methadone, buprenorphine, and naltrexone (a group of medicines called opiates) are used to in treatment of opioid addiction.

Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified.
Used properly and with phycological therapies the evidence base says it helps manage addiction.

As of March 2017 here are 3 main choices for medication.

Methadone stops withdrawal symptoms, reduces cravings and has similar effects to heroin but doesn’t deliver the same high as heroin. Methadone gives the person a chance to get their life and social situation back together. It is available as tablets, a liquid and injection.

Methadone is a sedative drug that depress the nervous system. Its effects can start quickly and can last several hours.
These effects include:

  • Slowing down body functioning and reducing physical and psychological pain
  • Feelings of warmth, relaxation and detachment
  • Relieving feelings of anxiety
  • Depressing the nervous system and the breathing, with risk of fatal overdose.

A common daily dose of methadone is between 40 mg and 120 mg. This needs to be monitored and changed depending on how well you are doing with it. Methadone takes about 30-60 minutes to work and the effect wears off in about 24 hours.
There may still be some problems with opiate withdrawal symptoms, depending how fast methadone is withdrawn but this substitution treatment is much less severe than going ‘cold turkey’.

Side effects

Some of methadone’s more common side effects are:

  • Headaches
  • Sleepiness
  • Insomnia
  • Sweating
  • Nausea and vomiting
  • Constipation
  • Fainting and dizziness
  • Sweating

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed above. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist.

Buprenorphine is also known by the brand names Subutex®, Prefibin® and Suboxone®. All these are sub-lingual tablets i.e. they have to be placed under the tongue to get in the body. They don’t work if you swallow the tablets because the buprenorphine is destroyed by the acid in the stomach. Subutex® and Prefibin® just contain buprenorphine. Suboxone® contains buprenorphine and naloxone.

Buprenorphine works in a similar way to Methadone to trick the brain into thinking it is still getting the problem opioid. Making you feel normal again, not high.

Naltrexone

Naltrexone is commonly known by the brand names Nalorex®, Revia® Opizone®. and Adepend®. It is licensed for both alcohol and drug dependency.

Naltrexone blocks opioids from acting on the brain, so it takes away the reward of getting high on the problem drug. This feature makes naltrexone a good choice for preventing relapse (falling back into problem drug use) and it can be used for long term treatment.

Naltrexone may not stop drug cravings. If it does not help with cravings, your doctor or  treatment provider will help you find other ways to reduce them. Naltrexone comes in pill form. For opiate dependence, the usual starting dose is 25mg (half a tablet) for the first day, then going up to 50mg a day. Because each dose lasts for a while, it can sometimes be taken three times a week (e.g. 100mg on Monday, 100mg on Wednesday and 150mg on Friday).

Naltrexone may be a good choice if you are completely past withdrawal and want to stay in recovery. It may also be suitable for you if you are in an early stage of addiction.

You must have no opioids in your body before starting naltrexone, otherwise it will cause bad withdrawal symptoms. You can start naltrexone after detox is completed.

Common side effects:

  • Upset stomach / vomiting
  • Diarrhea
  • Headache
  • Nervousness
  • Sleep problems / tiredness
  • Joint or muscle pain

Don’t go through the process of recovery alone. There are people who can help you with the struggles you’re facing. Get in touch with one today.

Funded by an educational grant from Indivior