Psychosocial Treatment

Addiction is a chronic illness, and even if better medications are discovered, recovering addicts will always have to make changes in their lives, just like people treated for other chronic illnesses like high blood pressure or diabetes. Behavior therapy helps them identify people, places, and things, as well as feelings, that promote addiction. Then they may learn to avoid the external cues (stimulus control) and neutralize the feelings (urge control).

Addicts can be exposed to cues like a hypodermic needle or a whiskey bottle while tamping down the usual response with relaxation training. Social skills and problem-solving training show them how to refuse offers of drugs, develop other interests and skills, handle stress without recourse to intoxication, and recruit the remaining strength of the frontal cortex to stop and think about the consequences of relapse. Cognitive therapy teaches them to dismiss catastrophic thinking that turns temporary relapses into disasters. Contingency management changes their incentives by providing praise and small rewards for resisting the drug. Through couples and family therapy, the addict appeals to loved ones for support. Group therapy and self-help groups help addicts find new companions and show them how to help themselves by helping others. Therapeutic communities remove addicts from environments pervaded with reminders of the drug.

So far, there is little evidence that any one of these treatments is better than any other for most addicts. Addiction involves many aspects of a person’s life, and addictive memories take command for a variety of reasons, so different recovery techniques work for different people and in different situations. One study found that the addicts most likely to stave off relapse were those who use the greatest variety of strategies.

Treatment for addiction is sometimes questioned on the grounds that it is ineffective and that drug use is a matter of choice. In fact, only about 20% of addicts recover the first time they are treated. But the treatment of other chronic illnesses often fails, too. Most people who develop cancer will die despite everything medicine does for them, but the effort is never questioned and insurance coverage is not limited. Just as people do not choose to have cancer, they do not choose to become addicts, even if they have chosen to use drugs in the first place. The brain studies are beginning to show how the capacity for choice is impaired by addiction, and why it must be regarded — and treated — as a chronic relapsing disorder of learning and memory.

References

Dackis C, et al. “Neurobiology of Addiction: Treatment and Public Policy Ramifications,” Nature Neuroscience (November 2005): Vol. 8, No. 11, pp. 1431–41.

Hyman SE, et al. “Neural Mechanisms Of Addiction: The Role of Reward-Related Learning and Memory,” Annual Review of Neuroscience (2006): Vol. 29, pp. 565–98.

Kleber HD, et al (eds). Practice Guideline for the Treatment of Patients with Substance Abuse Disorders, Second Edition. American Psychiatric Press, 2006.

Nestler EJ. “Is There a Common Molecular Pathway for Addiction?” Nature Neuroscience (November 2005): Vol. 8, No. 11, pp. 1445–50.

Schoenbaum G, et al. “Orbitofrontal Cortex, Decision-Making, and Drug Addiction,” Trends in Neuroscience (February 2006): Vol. 29, No. 2, pp. 116–24.