General treatment

According to the National Institute on Drug Abuse (NIDA), a care strategy must take into consideration all aspects of addiction; consequently, treatments must touch both biology and behavior as well as the social context³. Treatments should be tailored to each individual, as no treatment can apply to all people. Moreover, according to an article published in the medical journal The Lancet, in 1996: “It is unrealistic to expect recovery after treatment, nor would it be for any chronic disease. The lasting changes brought about by the use of addictive drugs remain after withdrawal and require continued maintenance treatment – whether psychosocial, pharmacological, or both. “⁴

The classic approach has two aspects

To achieve weaning, it is obviously first necessary to stop consuming and to implement the necessary means to no longer be in contact with the substance. If withdrawal leads to serious manifestations (psychotic delirium or depression), it is necessary to consult a doctor. Treatment of addiction includes pharmaceuticals and behavioral interventions.

Pharmacotherapy

For the moment, there is no pharmacological treatment for addiction. In contrast, drugs have been shown to be effective in treating some side effects during withdrawal, such as depression or seizures. These include antidepressants, dopamine regulators (amantadine, apomorphine, bromocriptine) and anticonvulsants. In users addicted to both opiates (for example, heroin) and cocaine, studies have shown that methadone can help reduce cocaine use².

Behavioral interventions

The next step is to find psychotherapeutic help to prevent relapses.

La cognitive-behavioral therapy, also called the “behavioral” approach, is based on the idea that learning processes play a determining role in the development of maladaptive behavior; therefore, anyone can unlearn one behavior and learn another, better suited (to their current needs). New behaviors learned during counseling allow the individual to use the appropriate strategy (different from person to person) to:

– avoid any contact with the substance;

– deal with cravings;

– recognize the warning signs of a state of withdrawal and find the means to avoid it;

– resist the urge to use again.

According to the NIDA, experience shows that the skills acquired during therapy of this type remain accessible to addicts after the end of their treatment. In many cases, counseling with family members and relatives is also necessary in order to help them communicate appropriately with the dependent person and to support him in his process.

NIDA also recommends training sessions psychotherapy specially adapted to the needs of drug addicts. Emphasis should be placed on the role drugs play in relation to feelings and behavior, and on finding solutions without resorting to drugs. The approach should cover two components:

– support to help people talk about their personal experiences;

– communication techniques to help people identify and act on interpersonal relationship problems.

Support from peers (other addicts who no longer use) is important in the recovery process. Most of support groups use the 12-step approach, developed decades ago for alcoholics and widely practiced around the world for all kinds of addictions. For cocaine users, the movement is called Narcotics Anonymous (NA). There are over 350 NA groups in Quebec, and nearly 20 around the world, that meet at least once a week. The work of the 000 steps includes an analysis of the psychological roots of addiction.

Notes. For people whose dependence is considerable or who experience serious psychosocial problems related to their drug addiction, stays in a detoxification center allow the combination of withdrawal, counseling and a support group in the same environment, under supervision.