Finding Calm: Options for Anxiety Treatment

Anxiety is a normal reaction to stress and can be a useful response in certain situations. It alerts us to dangers and helps us prepare and pay attention. But anxiety disorders are more than normal feelings of nervousness or anxiousness—they involve excessive fear or anxiousness which can negatively impact everyday life.

If you often feel anxious, whether or not you’ve been diagnosed with an anxiety disorder, the steps to seeking help can seem overwhelming. For some, rehab for anxiety is a good place to start.

Anxiety disorders are the most common type of mental disorder ((Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610617/)) and affect over 30% of adults at some point in their lives. Different risk factors can make it more likely for someone to develop an anxiety disorder. These include stressful life events, a family history of anxiety and other mental health issues, a history of trauma, and certain medical conditions.

In order to begin healing, it’s important to understand your personal experience with anxiety. Finding a rehab program that specializes in treating anxiety disorders may be a step in that process.

Where Does Anxiety Come From?

As humans, our bodies have evolved to protect us in moments of danger. As such, our nervous system is continually scanning for threats as a way to keep us safe. When our body detects that there’s some kind of threat (whether it’s an oncoming car or just a loud noise), it reacts in a way that is likely to keep us safe. As the threat passes, our bodies regulate and return to a calmer state.

Chronic anxiety happens when a person’s body isn’t able to complete the cycle and return to a regular state. Instead, it stays at alert when it doesn’t need to. Anxiety is an adaptive response that helps keep us alive in dangerous situations. But staying in this elevated state can be distressing and bad for our physical health.

If you suffer from anxiety, it can be difficult to find a sense of calm even when you know you’re safe.

Signs and Symptoms of Anxiety

Anxiety Assessment

In the first stage of treatment, a mental health specialist will take you through an assessment process to see if you meet the criteria for an anxiety disorder. ((What are anxiety disorders? (n.d.). Retrieved March 28, 2022, from https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders)) Results of the assessment will guide your treatment recommendations. Common types of anxiety disorders and their symptoms are listed below:

Generalized Anxiety Disorder (GAD)
The most common diagnosis is generalized anxiety disorder. To receive this diagnosis, a person needs to show persistent and excessive worry that interferes with daily activities.

Panic Disorder
Panic disorder involves experiencing panic attacks in response to a feared object or at unexpected times. Symptoms include rapid heart rate, sweating, shaking, feeling short of breath, chest pain, dizziness, numbness or tingling, chills or hot flashes, nausea, and fear of losing control or dying.

Phobia
A phobia is an excessive and persistent fear of a specific object, situation, or activity that’s generally not harmful. Examples are a fear of public speaking, fear of flying, or fear of spiders. A person with a phobia may avoid certain situations, or experience extreme distress when facing their fear.

Agoraphobia
A person with agoraphobia fears situations where escape may be difficult or embarrassing. They experience fear in at least two of these circumstances: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, or being outside the home alone.

Social Anxiety Disorder
Social anxiety disorder involves significant anxiety and discomfort about being embarrassed, humiliated, or looked down on in social interactions. Two examples are extreme fear of public speaking, and eating or drinking in public.

Separation Anxiety Disorder
Separation anxiety disorder is when a patient is excessively fearful or anxious about separation from people they’re close to. The feeling is beyond what’s appropriate for the person’s age, lasts over time, and causes problems functioning.

Selective Mutism
Selective mutism is diagnosed in cases where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they don’t see very often.

Causes of Anxiety

People struggle with anxiety due to a combination of genetic, environmental, psychological, and other factors. Because we know that anxiety disorders can run in families, it’s likely that a combination of genes and environmental stresses lead to anxiety disorders. ((What are anxiety disorders? (n.d.). Retrieved March 28, 2022, from https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders))

Research shows that anxiety and sensory sensitivity are related. People who are more sensitive to sensory input may have higher levels of anxiety than others. Each of us has our own breaking point of when our nervous system becomes overstimulated. When surroundings are too bright, too loud, or too intense in other ways, everyday environments can get overwhelming.

Sometimes, medical conditions produce anxiety. ((Anxiety disorders—Symptoms and causes. (n.d.). Mayo Clinic. Retrieved March 28, 2022, from https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961)) People with heart disease, diabetes, thyroid issues, respiratory disorders, chronic pain, or digestive issues often experience anxiety as a symptom.

Symptoms of Anxiety

Anxiety symptoms can develop in childhood or later in life, and it’s common for patients to have other mental health or medical diagnoses along with an anxiety disorder. It’s important to keep in mind that anxiety might look different across people and cultures.

Everyone’s experience is different, but there are some common comorbidities of anxiety disorders:

  • depression (which often occurs with an anxiety disorder)
  • other mental health disorders
  • substance misuse
  • trouble sleeping (insomnia)
  • digestive issues
  • headaches
  • chronic pain
  • social isolation
  • difficulty functioning at school or work
  • poor quality of life
  • increased risk of suicide

Anxiety can also take the form of physical symptoms. ((Haug, T. T., Mykletun, A., & Dahl, A. A. (2004). The association between anxiety, depression, and somatic symptoms in a large population: the HUNT-II study. Psychosomatic Medicine, 66(6), 845-851.)) These include fibromyalgia, nausea, heartburn, impaired motor activity, and impaired vision. Even when there’s not a medical diagnosis to explain these physical symptoms, they’re still important to notice. They may signal that your body is experiencing chronic anxiety.

The Impacts of Living With Anxiety

Anxiety often happens internally but it may also have a serious impact on your life.

Physical Health

Anxiety takes a toll on the body. Because they have high levels of cortisol and other stress hormones, people who are chronically anxious may have problems with heart disease, ((Celano, C. M., Daunis, D. J., Lokko, H. N., Campbell, K. A., & Huffman, J. C. (2016). Anxiety disorders and cardiovascular disease. Current Psychiatry Reports, 18(11), 101. https://doi.org/10.1007/s11920-016-0739-5)) high blood pressure, and immune system deficiencies.

People with chronic anxiety sometimes experience chronic inflammation, like gut inflammation. Chronic anxiety can also shorten life expectancy.

Stigma

Public stigma toward people with anxiety disorders ((Curcio, C., & Corboy, D. (2020). Stigma and anxiety disorders: A systematic review. Stigma and Health, 5(2), 125.)) and other mental health diagnoses can take a toll on a person, and lead to self-stigma. These negative attitudes are often based on the misconception that anxiety happens because of personal weakness, instead of it being a legitimate condition that calls for support.

Quality of Life

Even if you don’t fit the criteria for an anxiety diagnosis, its symptoms can get in the way of leading the life you want. Anxiety can negatively impact quality of life, ((Olatunji, B. O., Cisler, J. M., & Tolin, D. F. (2007). Quality of life in the anxiety disorders: A meta-analytic review. Clinical Psychology Review, 27(5), 572–581. https://doi.org/10.1016/j.cpr.2007.01.015)) including work, social relationships, home, and family.

Isolation and Loneliness

Anxiety may be very distressing at times. As a result, you may begin to avoid situations that trigger anxiety. ((Eustis, E. H., Cardona, N., Nauphal, M., Sauer-Zavala, S., Rosellini, A. J., Farchione, T. J., & Barlow, D. H. (2020). Experiential avoidance as a mechanism of change across cognitive-behavioral therapy in a sample of participants with heterogeneous anxiety disorders. Cognitive Therapy and Research, 44(2), 275-286.)) In some cases, this might be a useful response, but in others, it means missing out on the important events and relationships that make living worthwhile.

When your diagnosis impacts the rest of your life, it might be hard to imagine a way to heal. Remember that you deserve care. And fortunately, there are treatments available.

Anxiety and Substance Use Disorders

People with anxiety are uniquely vulnerable to substance misuse. For many, using a substance can temporarily lower their anxiety levels. But, anxiety is also a side effect of substance use. You may feel anxious when you stop using alcohol, anti-anxiety medications, or other substances, including caffeine. ((O’Neill, C. E., Newsom, R. J., Stafford, J., Scott, T., Archuleta, S., Levis, S. C., Spencer, R. L., Campeau, S., & Bachtell, R. K. (2016). Adolescent caffeine consumption increases adulthood anxiety-related behavior and modifies neuroendocrine signaling. Psychoneuroendocrinology, 67, 40–50. https://doi.org/10.1016/j.psyneuen.2016.01.030))

Dr. Rocco A. Iannucci, Psychiatrist and Director of Fernside at McLean Hospital, stresses the relationship between anxiety and substance misuse:

“We know from major studies in the community that as many as half of people who have an addiction also have another mental health issue, like depression or anxiety, and we also know that really the best practice is to address both problems at the same time. You could leave yourself in the situation of helping someone stop drinking, for example, and then they end up feeling terribly depressed if you don’t help them with that problem. That really leaves them vulnerable to a relapse.”

If you’re experiencing both anxiety symptoms and a substance use disorder (i.e. a co-occurring disorder), there are a number of rehab programs that may be right for you.

Treatments for Anxiety

Healing looks different for everyone. Fortunately, there are a good number of scientifically supported anxiety treatments. ((Anxiety disorders. (n.d.). National Institute of Mental Health (NIMH). Retrieved March 28, 2022, from https://www.nimh.nih.gov/health/topics/anxiety-disorders))

Two main goals of anxiety-focused interventions are: 1) to help your body regulate itself so that anxiety responses are less intense, and 2) to learn useful ways to acknowledge and move through anxiety when it shows up.

Medication

Many people use medication to manage anxiety. ((Medication | anxiety and depression association of america, adaa. (n.d.). Retrieved from https://adaa.org/find-help/treatment-help/medication-options)) Some of the most frequently used options include anti-anxiety drugs (such as benzodiazepines), antidepressants (including SSRIs and SNRIs), and beta-blockers.

For some people, medication may be an effective way to lessen the impact of anxiety attacks and other symptoms of chronic anxiety. Making this change at the physical level might also mean that other kinds of interventions start to feel feasible.

Psychotherapy

One intervention for anxiety is cognitive behavioral therapy (CBT). ((Beyond worry: How psychologists help with anxiety disorders. (n.d.). Https://Www.Apa.Org. Retrieved from https://www.apa.org/topics/anxiety/disorders)) With this approach, you’ll learn how your thoughts contribute to your anxiety struggles and how to change those thought patterns. You’ll also learn how to reduce anxious behaviors by experiencing different challenging situations. Most treatment programs for anxiety offer CBT. You can also get treatment at home through virtual therapy sessions.

In exposure therapy, ((What is exposure therapy? (n.d.). Https://Www.Apa.Org. Retrieved March 28, 2022, from https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy)) a therapist creates a safe environment where you’re exposed to the things you fear and avoid. In sessions, you might be asked to interact directly with the feared situation. You also practice managing your anxiety while imagining the trigger, or interact with it using virtual reality. The goal is to decrease the intensity of anxious reactions and to show that you’re capable of navigating the situation.

Another therapy approach is dialectical behavior therapy (DBT). ((Therapy | anxiety and depression association of america, adaa. (n.d.). Retrieved from https://adaa.org/find-help/treatment-help/types-of-therapy)) A DBT therapist supports you as you build skills for interpersonal effectiveness, tolerating distress, and regulating emotions. Sessions can be one-on-one or in small groups, with weekly homework assignments that help you apply what you’re learning to your everyday life.

Acceptance and commitment therapy ((Therapy | anxiety and depression association of america, adaa. (n.d.). Retrieved from https://adaa.org/find-help/treatment-help/types-of-therapy)) (ACT) is an approach where the the focus is on changing the relationship you have with your anxiety so that you suffer less. By accepting that your feelings of anxiety when they come up, it becomes possible to find new and creative ways to navigate it and behave in ways that are in line with your values at the same time.

Physical Activity

Being physically active can lower anxiety. ((Firth, J., Solmi, M., Wootton, R. E., Vancampfort, D., Schuch, F. B., Hoare, E., Gilbody, S., Torous, J., Teasdale, S. B., Jackson, S. E., Smith, L., Eaton, M., Jacka, F. N., Veronese, N., Marx, W., Ashdown‐Franks, G., Siskind, D., Sarris, J., Rosenbaum, S., … Stubbs, B. (2020). A meta‐review of “lifestyle psychiatry”: The role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry, 19(3), 360–380. https://doi.org/10.1002/wps.20773)) If you’re looking for ways to manage panic attacks and anxious feelings without medication, you could consider a focus on movement-based activities.

But physical activity doesn’t have to happen in a gym or on a yoga mat. Meaningful movement can look like gentle stretching, going for a walk or bike ride, or taking a short dance break in between other daily activities.

Breathwork Exercises

Mindfulness, meditation, or other kinds of breathing exercise are useful ways to regulate your nervous system, slow your heart rate, and connect to the present moment. But be sure to pay attention to whether it’s actually working for you. If an exercise is increasing feelings of panic and emotional distress, it may be more harmful than helpful. You could consider adjusting your mindfulness practice ((Treleaven, D. A. (2018). Trauma-sensitive mindfulness: Practices for safe and transformative healing. WW Norton & Company.)) by taking more frequent breaks, spending a shorter amount of time on the exercise, or trying another type of exercise altogether.

Polyvagal Interventions

A Polyvagal Theory ((Porges, S. W., & Dana, D. (2018). Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal-Informed Therapies (Norton Series on Interpersonal Neurobiology). WW Norton & Company.)) approach helps a patient regulate their nervous system. Some activities can be done solo, like humming or singing, drinking water, or using a weighted blanket.

Other activities are done with another person, like a therapist or loved one. For example, the Safe and Sound Protocol ((Porges, S. W. (2018). Polyvagal theory: A primer. Clinical applications of the polyvagal theory: The emergence of polyvagal-informed therapies, 50, 69.)) involves listening to music that’s been processed specifically to retune the nervous system. This creates a sense of safety and may make it easier to be social with others. Massage, hugs, and other types of physical closeness are other examples of co-regulation activities for lowering anxiety and creating a felt sense of safety and social connection.

When it comes to successfully navigating your anxiety, it’s important to focus on what you need in the moment and from your environment, rather than trying to change yourself in order to cope with overwhelm. Acknowledge your experience for what it is, and try to approach your anxiety with self-compassion.

Moving Beyond Worry

Living with anxiety can be challenging; it can create distress and make it hard to participate in meaningful parts of life. But it’s an extremely common mental health struggle, and there is hope. There are lots of interventions and helpful resources for managing anxiety.

Just like you, your healing process will be unique. You can explore what kinds of supports feel like the best fit as you learn to move through anxiety as it comes up. Make sure to find a treatment program that meets your specific needs.

To learn more about treatment for this condition, browse our list of rehabs specializing in anxiety disorder treatment.

Reviewed by Rajnandini Rathod

FAQs: Detoxing From Substance Use

Detox is one of the first steps in recovery from a substance use disorder. During this process, you’ll stop using the substances in question and allow them to leave your system. Depending on the severity of your addiction, you may experience withdrawal symptoms.

The experience of detox is almost always uncomfortable. And in some cases, it can even be physically risky. It’s important to undergo this process with proper supervision. For some patients, that means receiving highly specialized medical treatment. Others may be able to detox in a less formal setting. But no matter where you begin healing, you’ll likely go through a similar process of withdrawal.

What Happens During Detox?
How Long Does Detox Last?
When is Detox Required?

What Types of Detox Treatment are Available?
Detox in a Hospital Settings
Medical Detox Centers
Residential Rehabs
Detoxing At Home
How Much Does Detox Cost?

What Happens During Detox?

When you first stop using a substance, you’ll go through withdrawal. ((Kelly, J. F., Saitz, R., & Wakeman, S. (2016). Language, substance use disorders, and policy: The need to reach consensus on an “addiction-ary.” Alcoholism Treatment Quarterly, 34(1), 116–123. https://doi.org/10.1080/07347324.2016.1113103)) This is a series of “physical, cognitive, and affective symptoms that occur after chronic use of a drug is reduced abruptly or stopped among individuals who have developed tolerance to a drug.”

The exact symptoms of withdrawal vary based on a number of factors, including but not limited to which substance(s) you were using, the amount you used on a daily basis, and your overall physical health. During detox, ((» detox. (n.d.). Retrieved from https://www.recoveryanswers.org/resource/alcohol-and-drug-detox/)) you may experience anxiety, depression, hallucinations, tremors, changes in blood pressure, gastrointestinal symptoms, insomnia, and irritability.

How Long Does Detox Last?

Fortunately, these symptoms last only a few days for most patients. On average, detox lasts for 3 to 7 days. The timeline is longer for certain drugs. For example, it can take up to 14 days for withdrawal symptoms from opiates and benzodiazepines to peak.

Many patients, especially those recovering from opiate misuse, progress through 3 basic stages of withdrawal. ((Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & Usa, 20894. (2006). 4 physical detoxification services for withdrawal from specific substances. Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK64116/)) First, during early withdrawal, in which you begin to experience intense cravings and physical symptoms. This is often followed by peak withdrawal, with stronger symptoms, and then late withdrawal, in which symptoms should become more manageable.

Although the timeline is usually short, many patients experience severe physical and emotional symptoms during detox and withdrawal. It’s highly recommended that all substance users seek out supervised detox—and for some patients, this supervision is absolutely necessary. If you’re planning to stop using alcohol, opiates, or benzodiazepines, detoxing without medical care can be life-threatening.

When is Detox Required?

Medical detox is absolutely necessary for some patients. Before you decide on a specific course of treatment—and before you discontinue substance use—it’s best to get a medical evaluation. Your primary care doctor should be able to connect you with a qualified professional who can help. Alternatively, some rehab facilities can conduct over-the-phone detox evaluations during your initial call.

These assessments help quantify the risks associated with withdrawal, given your specific health history. But if you have a history of using certain substances, it’s very likely that your doctor will recommend medical detox.

Alcohol

After prolonged and/or heavy alcohol use, you can expect to go through severe withdrawal symptoms. ((Alcohol withdrawal. (2019, April 22). Harvard Health. https://www.health.harvard.edu/a_to_z/alcohol-withdrawal-a-to-z)) These symptoms include insomnia, anxiety, and a serious condition called delirium tremens.

Delirium tremens (DT) can be debilitating and even fatal without proper medical care. This condition “typically begins 24 hours or longer following acute cessation of alcohol and is a life-threatening form of alcohol withdrawal ((» detox. (n.d.). Retrieved from https://www.recoveryanswers.org/resource/alcohol-and-drug-detox/)) involving sudden & severe changes in the mental and nervous system. These changes can cause severe mental confusion and hallucinations.” DT is often associated with other risk factors, including electrolyte imbalance and head injury.

If you exhibit any of these symptoms, your medical team can prescribe certain medications to help manage alcohol withdrawal. ((Grover, S., & Ghosh, A. (2018). Delirium tremens: Assessment and management. Journal of Clinical and Experimental Hepatology, 8(4), 460–470. https://doi.org/10.1016/j.jceh.2018.04.012)) While benzodiazepines may be helpful, these medications must be taken under close supervision, because they also have the potential to be addictive.

Benzodiazepines

Medications like Valium and Xanax are commonly prescribed for anxiety. According to the National Institute on Drug Abuse, “Although they are highly effective for their intended uses, these medications must be prescribed with caution because [benzodiazepines] can be addictive.” ((https://plus.google.com/+NIDANIH. (2012, April 19). Well-known mechanism underlies benzodiazepines’ addictive properties. https://archives.drugabuse.gov/news-events/nida-notes/2012/04/well-known-mechanism-underlies-benzodiazepines-addictive-properties))

For patients who misuse or overuse them, benzodiazepine withdrawal ((Pétursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction (Abingdon, England), 89(11), 1455–1459. https://doi.org/10.1111/j.1360-0443.1994.tb03743.x)) is associated with severe and possibly fatal side effects. During detox, patients with a physiological dependence on these drugs may experience “sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry retching and nausea, some weight loss, palpitations, headache, muscular pain and stiffness and a host of perceptual changes…seizures and psychotic reactions.” It is absolutely vital that these patients receive medical care during the detox process. In order to manage your withdrawal from benzodiazepines, ((Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & Usa, 20894. (2009). Withdrawal management. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK310652/)) your doctors will help you slowly taper down your usage. In some cases, they will also prescribe additional medications to help alleviate some of your symptoms.

Opiates

In the U.S., we are currently experiencing an opioid crisis. ((Division (DCD), D. C. (2018, May 8). Opioid crisis statistics [Text]. HHS.Gov. https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html)) Abuse of these drugs, which may be prescribed or illicit substances, is extremely common. Some of the more commonly misused opioids include oxycodone, hydrocodone, morphine, methadone, fentanyl, and heroin.

Since they’re often prescribed for physical pain, it can be especially difficult to distinguish between addiction and proper use of these drugs. If you have a prescription for painkillers, it’s extremely important to take them only as directed, and to stay in close communication with your medical team and your personal support network about your relationship with opiates.

Opiate withdrawal can be lethal ((Yes, people can die from opiate withdrawal | NDARC – National Drug and Alcohol Research Centre. (n.d.). Retrieved from https://ndarc.med.unsw.edu.au/blog/yes-people-can-die-opiate-withdrawal)) in the short term, partly due to potentially severe gastrointestinal side effects. And in the long term, former opiate users may be at risk of developing post-acute withdrawal syndrome ((Post-acute withdrawal syndrome (Paws) | semel institute for neuroscience and human behavior. (n.d.). Retrieved March 25, 2022, from https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS)) (PAWS). With this condition, patients may experience irritability, depression, obsessive-compulsive behaviors, anxiety, and an increased sensitivity to stress.

After stopping narcotic use, most people progress through three clearly defined stages of opioid withdrawal, ((Opioid withdrawal timeline: Symptoms, stages, recovery, and more. (2021, March 31). https://www.medicalnewstoday.com/articles/opioid-withdrawal-timeline)) as follows:

  • Early Stage: Symptoms begin at the expected time of the first missed dose. Patients may experience cravings, anxiety, an intense preoccupation with opioid use, and flu-like physical symptoms.
  • Peak Stage: Starting 1-2 days after the cessation of drug use, cravings reach their highest intensity. During this stage, you may also exhibit more severe gastrointestinal symptoms (such as nausea and vomiting), increased heart rate and blood pressure, sweating, and insomnia.
  • Late Stage: In most cases, these symptoms will begin to decrease within 7 days of your last dose. Physical withdrawal symptoms disappear, and psychological symptoms decrease.

At every stage of this process, it’s common—and often necessary—for doctors to prescribe nonaddictive medications, intended to alleviate your most severe symptoms. You may even be prescribed other narcotics, such as methadone. ((Methadone. (n.d.). Retrieved from https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone)) These prescriptions should only be taken as directed, under the close supervision of a medical team.

What Types of Detox Treatment are Available?

Depending on which substances you’re detoxing from, you may be eligible for various types of treatment. In most cases, though, detox programs provide some combination of psychotherapy, non-addictive prescriptions, and medical monitoring. If you have any co-occurring medical conditions, or you’re detoxing from alcohol, benzodiazepines, or opiates, inpatient detox is highly recommended.

Detox in a Hospital Setting

In a hospital environment, your providers will likely focus on managing the physical symptoms of withdrawal. You can expect 24-hour care, with a team of doctors and nurses monitoring your vital signs. This setting is ideal for patients with additional diagnoses, and especially chronic illnesses. Because substance misuse may have an impact on your use of other prescriptions, it’s important to get medical support during this transitional period.

Hospitals may or may not be able to provide the same level of psychological care as other facilities. If you have a co-occurring mental health diagnosis, one of the following detox settings might be a better fit.

Medical Detox Centers

Some treatment centers focus entirely on medical detox. These centers provide similar services to both rehabs and hospitals. You’ll be monitored by a team of doctors and nurses, and also have regular sessions with a psychotherapist. You may also work with other healing professionals, such as a nutritionist or even a massage therapist.

Most medical detox programs last for 1-2 weeks. Some also require that patients make plans for longer-term care before entering treatment. For example, you may need to enroll in a residential rehab program that will begin as soon as you complete detox. Other medical detox centers may help patients plan for aftercare during their stay.

Residential Rehab

Some residential rehabs allow patients to detox on-site. If you’d like to go through detox and longer-term treatment at the same facility, talk to your admissions team to learn more about your options.

Inpatient detox is absolutely necessary for some patients, and is highly recommended for most. However, it’s not accessible for everyone. Fortunately, you can still begin recovery while living at home.

Detoxing at Home

At-home detox may be appropriate for some clients. You can consider this option if you have a strong personal support network, you’re exhibiting only mild withdrawal symptoms. It’s also essential that you make a plan to obtain emergency medical care if your symptoms worsen.

No matter where you plan to detox, make sure you consult with a doctor before you discontinue substance use. Even if you decide to go through withdrawal at home, with little professional support, their advice can help you plan for your own safety. Detoxing at home is almost never safe for patients recovering from alcohol, benzodiazepine, or opioid misuse.

If this option is appropriate for you, there are some noteworthy benefits to outpatient detox. ((Hayashida, M. (1998). An overview of outpatient and inpatient detoxification. Alcohol Health and Research World, 22(1), 44–46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761814/)) Specifically, you may “​​retain greater freedom, continue to work and maintain day-to-day activities with fewer disruptions, and incur fewer treatment costs” compared to those who receive inpatient treatment.

How Much Does Detox Cost?

The cost of detox varies widely from one facility to another and is influenced by factors like facility type and the level of clinical care you receive. Detoxing from certain substances involves more intensive clinical services, which plays into final costs.

Low-cost detox programs are available. They’re usually offered at state-funded rehabs and some may even be free, though you’ll have to meet certain criteria to be eligible for most of these. In general, outpatient detox programs are more affordable than inpatient programs. On the low end, a private outpatient detox program can start at $250 per day.

A 30-day program at a private rehab center can cost less than $10,000 to over $75,000. In comparison to outpatient detox programs, these centers often offer additional therapeutic services on top of around-the-clock care during the initial stages of detox.

Many facilities accept insurance, including Medicaid. Make sure you check with your insurance provider, and your treatment provider’s admissions team, to see what portion of your costs can be covered by insurance.

What Happens After I Detox?

Recovery is a lifelong process, and detox is just the first step. It’s important to set realistic expectations, and understand that completing detox doesn’t mean you’ll be “fixed.”

After detox, many patients benefit from entering a longer-term treatment program. There are numerous ways to approach this. For example, you might attend residential rehab, or you might start an intensive outpatient program (IOP). Some patients join support groups, such as Alcoholics Anonymous ((Have a problem with alcohol? There is a solution. | Alcoholics Anonymous. (n.d.). Retrieved March 25, 2022, from https://www.aa.org/)) or SMART Recovery. ((Self-Help Addiction Recovery Program. | Smart Recovery. Retrieved from https://www.smartrecovery.org/))

These long-term groups and programs serve many purposes. For example, they might help you improve your physical and mental health, or heal your interpersonal relationships. But even with the right support, you’ll continue to face challenges. It’s normal to have cravings long after you successfully complete detox. Effective treatment doesn’t take away your triggers; instead, it helps you navigate them in a healthy way.
If you’re ready to take the next step toward recovery, you can browse medical detox centers here.

Reviewed by Rajnandini Rathod

Alcohol Addiction and Recovery

Alcoholism can be devastating. And because drinking is both legal and socially acceptable, it can be difficult to recognize when you have a problem. But when you’re ready to seek help, there are many ways to get treatment for alcohol addiction.

This substance use disorder may interfere with your physical and mental health, your work, and your most important relationships. In extreme cases, it can even be fatal. In order to find the right kind of treatment, it’s important to understand the severity of the problem.

Defining Alcoholism

Alcohol use disorder (AUD) is a medical condition ((Understanding alcohol use disorder | national institute on alcohol abuse and alcoholism(Niaaa). (n.d.). Retrieved March 25, 2022, from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder)) characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.” While it’s possible to drink in moderation, many people use alcohol unsustainably. Because the overuse of alcohol may begin in response to stress, it can be hard to recognize when the drug itself is exacerbating that stress.

This disorder is extremely common, both in the U.S. and internationally. In fact, “alcohol is the most common drug of abuse in our society and, as a consequence, alcoholism is a devastating socio-economic problem estimated to account for 4% of the global burden of disease.” Because of this, alcohol addiction has been the subject of a great deal of study, ((Budygin, E., & Weiner, J. (2015). Exploring the neurochemical basis of alcohol addiction-related behaviors: Translational research. Translational Biomedicine, 6(Suppl Spec), http://www.transbiomedicine.com/translational-biomedicine/exploring-the-neurochemical-basis-of-alcohol-addictionrelated-behaviors-translational-research.pdf. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710378/)) as experts attempt to distinguish between appropriate and unhealthy alcohol use.

Occasional or purely social drinking does not necessarily constitute a substance use disorder. However, for people who are already vulnerable to addiction—because of trauma, genetics, social circumstances, and similar factors—these seemingly acceptable behaviors can lead to AUD. And any amount of drinking can be dangerous for people who have a history of misusing alcohol.

According to the American Psychological Association, moderate drinking “lies at one end of a range that moves through alcohol abuse to alcohol dependence.” ((Understanding alcohol use disorders and their treatment. (n.d.). Https://Www.Apa.Org. Retrieved March 25, 2022, from https://www.apa.org/topics/substance-use-abuse-addiction/alcohol-disorders)) And because alcohol use disorders can worsen over time, your behavior may slowly progress through the following patterns, leading up to a time when you need help.

Moderate Alcohol Consumption

In the U.S., moderate alcohol consumption is defined by the CDC ((Alcohol questions and answers | cdc. (2021, February 16). https://www.cdc.gov/alcohol/faqs.htm)) and other government agencies as “limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more.” It’s important to note that the gender differences here are based on scientific research, not social norms.

According to the BBC, “researchers are finding that women’s bodies are affected differently by alcohol than men’s bodies ((Taylor, M. (n.d.). Why alcohol affects women more than men. Retrieved March 25, 2022, from https://www.bbc.com/future/article/20180618-why-alcohol-affects-women-more-than-men)) – for reasons that go beyond mere size. Scientists have discovered that women produce smaller quantities of an enzyme called alcohol dehydrogenase (ADH), which is released in the liver and breaks down alcohol in the body.”

For people of any gender, 1 to 2 drinks per day may seem like a low number. The difference between American social norms and the CDC’s definition of moderation is illuminating. With this information in mind, it’s not surprising that alcohol abuse is so prevalent.

Alcohol Abuse

Alcohol abuse is a drinking pattern ((Understanding alcohol use disorders and their treatment. (n.d.). Https://Www.Apa.Org. Retrieved March 25, 2022, from https://www.apa.org/topics/substance-use-abuse-addiction/alcohol-disorders)) that results in significant and recurrent adverse consequences.” People with AUDs may face problems at work, in school, or with family and friends. They may even encounter legal problems caused by drunken behavior, such as DUIs. Because alcohol misuse “is associated with poor decision-making,” ((Brevers, D., Bechara, A., Cleeremans, A., Kornreich, C., Verbanck, P., & Noël, X. (2014). Impaired decision-making under risk in individuals with alcohol dependence. Alcoholism, Clinical and Experimental Research, 38(7), 1924–1931. https://doi.org/10.1111/acer.12447)) habitual drinkers often engage in reckless behavior. The results of that behavior can range from inconvenient to violent, and may have long-lasting effects on your life.

It’s never too soon to begin recovery. If you exhibit any of the signs of alcohol use disorder, it’s best to seek treatment immediately. And it’s even better if you can get help before developing a physical dependence on alcohol.

Alcohol Dependence

Over time, people who abuse alcohol often develop a dependence on the drug. In this stage, a person has “lost reliable control of their alcohol use.” You may be at this stage even if you occasionally take a day off from drinking. “Alcohol dependence is characterized by tolerance ((Understanding alcohol use disorders and their treatment. (n.d.). Https://Www.Apa.Org. Retrieved March 25, 2022, from https://www.apa.org/topics/substance-use-abuse-addiction/alcohol-disorders)) (the need to drink more to achieve the same ‘high’) and withdrawal symptoms if drinking is suddenly stopped.”

If you’re physically dependent on alcohol, you should absolutely not attempt to stop drinking on your own. Without proper medical supervision, detox can be extremely dangerous and even fatal. Alcohol withdrawal has “a broad range of symptoms ((Newman, R. K., Stobart Gallagher, M. A., & Gomez, A. E. (2022). Alcohol withdrawal. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK441882/)) from mild tremors to a condition called delirium tremens, which results in seizures and could progress to death if not recognized and treated promptly. The reported mortality rate for patients who experience delirium tremens is anywhere from 1 to 5%.”

Although the prospect of withdrawal may be daunting, continuing to drink heavily is equally dangerous, if not more so. Long-term alcohol abuse can have countless physical effects, ((Alcohol’s effects on the body | national institute on alcohol abuse and alcoholism(Niaaa). (n.d.). Retrieved March 25, 2022, from https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body)) possibly causing harm to the heart, liver, pancreas, and immune system, and even causing cancer. This behavior can also severely damage your interpersonal relationships.

The Impacts of Alcohol Abuse

Research has conclusively demonstrated that “alcoholism has a pervasive detrimental impact on family life. ((Rotunda, R., & Scherer, D. (1995). Family Systems and Alcohol Misuse: Research on the Effects of Alcoholism on Family Functioning and Effective Family Interventions. Professional Psychology Research and Practice, 26(1), 95–104. https://www.researchgate.net/profile/David-Scherer-2/publication/232449776_Family_Systems_and_Alcohol_Misuse_Research_on_the_Effects_of_Alcoholism_on_Family_Functioning_and_Effective_Family_Interventions/links/54c948580cf298fd262460b9/Family-Systems-and-Alcohol-Misuse-Research-on-the-Effects-of-Alcoholism-on-Family-Functioning-and-Effective-Family-Interventions.pdf)) Alcoholism contributes to marital and family discord, loss of employment and difficulty sustaining job performance, legal conflicts, verbal and physical abuse, inadequate parenting, and sexual inadequacy.”

Many people with AUDs struggle with unhealthy interpersonal dynamics, and report that the quality of their intimate relationships has suffered. This applies not only to romantic partnerships, but also to more complex dynamics. If just 1 person in a family has an alcohol use disorder, ((McCrady, B., & Flanagan, J. (2021). The role of the family in alcohol use disorder recovery for adults. Alcohol Research Current Reviews, 41(1). https://arcr.niaaa.nih.gov/recovery-aud-part-2/role-family-alcohol-use-disorder-recovery-adults#article-toc2)) the entire family is affected. For example, their spouse, children, or siblings may need to take on additional responsibilities in order to make up for their poor behavior. Social events may also be disrupted, including important milestones like weddings or graduations.

Alcohol abuse can even represent a physical danger to family members. According to the WHO, “Evidence suggests that alcohol use increases the occurrence and severity of domestic violence.” This can quickly lead to a vicious cycle, because intimate partner violence “can lead to alcohol consumption ((Intimate partner violence and alcohol. (n.d.). World Health Organization. https://www.who.int/violence_injury_prevention/violence/world_report/factsheets/fs_intimate.pdf)) as a method of coping or self-medicating.”

Unfortunately, these aren’t the only relationships that may be affected by alcohol abuse. ((Alcohol, violence, and aggression—Alcohol alert no. 38-1997. (n.d.). Retrieved from https://pubs.niaaa.nih.gov/publications/aa38.htm)) “Scientists and nonscientists alike have long recognized a two-way association between alcohol consumption and violent or aggressive behavior.” And that aggression may alienate people close to you, exposing you to triggers without the benefit of social support. It can be extremely difficult to find your way out of this cycle without professional help.

Why People Stop Drinking

It can be hard for some people to know when to stop drinking, either for the night or for good. And there’s a scientific reason for that. Karen Szumlinski, Professor of Neuroscience at the University of Santa Barbara, recently discovered a mechanism by which the human brain develops a temporary aversion to alcohol, which is activated when you’ve had enough (or too much) to drink.

Specifically, Szumlinski and her team studied a chemical process in a brain structure called the bed nucleus of the stria terminalis (BNST). This process, she says, “serves as a brake to reduce or at least curb your alcohol consumption. ((Tampering with the Brakes. (n.d.). The UCSB Current. Retrieved March 25, 2022, from https://www.news.ucsb.edu/2019/019354/tampering-brakes)) But if any kink happens in that little bit of signaling there, you lose the brakes. Your brake line has been cut, and now you exhibit uncontrolled drinking behavior.”

If you struggle to regulate your drinking habits, you may need help to realize you have a problem. Many people enter recovery due to the advice of loved ones.

Social Pressure to Reduce Drinking

According to experts, receiving social pressure to reduce drinking ((Polcin, D. L., Korcha, R., Greenfield, T. K., Bond, J., & Kerr, W. (2012). Pressure to reduce drinking and reasons for seeking treatment. Contemporary Drug Problems, 39(4), 687–714. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888964/)) is the main reason that most patients get help. One study found that more than 90% of respondents “received pressure from at least one source,” which may have been a loved one, an employer, or even the legal system.

It’s clear that the majority of people recovering from AUD depend on external voices to provide feedback and set boundaries. You may also decide for yourself that you want to improve your relationships. In the same study, 25% of people cited this desire as a reason to stop drinking.

Desire to Improve Health

Although interpersonal dynamics rank highest, some people also seek recovery to improve their own health. Alcohol abuse causes significant physical problems. This is true even for “functional alcoholics,” who may not notice the relationship issues caused by their drinking.

According to the National Institutes of Health, this subtype of people who misuse alcohol ((Researchers identify alcoholism subtypes. (2015, September 29). National Institutes of Health (NIH). https://www.nih.gov/news-events/news-releases/researchers-identify-alcoholism-subtypes)) makes up “19.5% of U.S. alcoholics. Typically middle-aged, well-educated, with stable jobs and families. About one-third have a multigenerational family history of alcoholism, about one-quarter had major depressive illness sometime in their lives, and nearly 50% were smokers.”

Although these patients may not exhibit visible or dramatic signs of an alcohol use disorder, they may experience dangerous physical symptoms that worsen over time. Perhaps for this reason, 15% of those in recovery have cited a desire to improve their health as a reason to stop drinking. ((Polcin, D. L., Korcha, R., Greenfield, T. K., Bond, J., & Kerr, W. (2012). Pressure to reduce drinking and reasons for seeking treatment. Contemporary Drug Problems, 39(4), 687–714. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888964/))

Treatment for Alcohol Addiction

When you’re ready to get help for alcohol abuse, there are numerous available treatments. You can choose between these options based on the severity of your addiction, and whether you’re physically dependent on alcohol. And as you progress through the stages of recovery, you’ll likely benefit from different forms of therapy.

Medical Detox

Medically supervised detox normally lasts for a matter of days. During this time, you’ll be closely monitored by a medical team, who may prescribe non-addictive medications to alleviate the physical symptoms of withdrawal. If you’re physically dependent on alcohol (or any other substance), detox can be uncomfortable or even dangerous. For that reason, it’s extremely important to undergo detox with proper medical care.

If you think you’d benefit from this type of care, you can learn about your options by reviewing our directory of medical detox centers here.

Either before or during your stay at a detox facility, you’ll work with a team to figure out what comes next. Physical healing is just the first step; focusing on mental health will help you avoid relapse and begin moving forward. If your addiction is severe enough to require inpatient detox, it’s absolutely vital that you also make a plan for longer-term recovery.

Inpatient Rehab

Inpatient rehab for alcohol misuse usually lasts for at least a few weeks, although some programs may allow you to stay longer. During your time in residence, you will probably engage in some combination of one-on-one talk therapy, group sessions, recreational therapy, experiential therapy, and other modalities. You may also work with a medical team to improve your physical health.

Remember that inpatient rehab is just one step in the long process of recovery. No matter how effective the program is, it’s unlikely that you’ll be completely “fixed” by the time you leave. Fortunately, most rehab providers are well-equipped to help you plan for life after rehab.

Intensive Outpatient Programs

Intensive outpatient programs (IOPs) provide addiction treatment while you live at home or in another facility. These programs can be appropriate for patients whose insurance won’t cover residential rehab.

In an IOP, you’ll likely attend daily therapy sessions, including individual counseling and support groups. Some programs let patients go to work or school at the same time. Others have a rigorous schedule, requiring you to attend therapy the way you might attend a job.

While these programs provide sufficient treatment for many patients, they don’t offer the same protected environment that you’d find in an inpatient rehab. This can leave you vulnerable to external triggers, including unstable relationships. However, people with strong community support may benefit from staying close to home during recovery.

Sober Living Environments

After initial treatment, such as detox or inpatient rehab, some patients move into sober living environments. Here, you’ll share a living space with a cohort of people who are also in recovery. This allows residents to both receive and provide support, practicing interpersonal skills.

Some sober living environments enforce a strict set of rules, such as a curfew or a minimum number of weekly support groups. You may also be required to attend individual therapy during your stay.

Alternatively, you may choose to live in a therapeutic community. These environments also have certain rules, and usually maintain a zero-tolerance policy regarding substance use. However, they use a more collaborative framework than some other facilities, giving residents greater responsibility and more say in how the house is run. These groups believe in the power of mutual support, and members rely on each other for mutual support throughout recovery.

You may be required to attend inpatient rehab before moving into a sober living environment. Every one of these programs has its own guidelines about each person’s length of stay. Some residents think of this time as a transitional period, spending only a few weeks on-site between receiving treatment and returning home. Other patients join these communities for the long term.

Support Groups

Support groups can be helpful at any stage of recovery. During inpatient rehab, most patients will attend some form of regular group meeting, whether it’s a peer-led program or a more structured therapy session. Alcoholics Anonymous (A.A.) is one well-known support group specifically designed to help AUD patients.

12-Step programs like A.A. are faith-based support groups. Members of A.A. are encouraged to “cultivate spirituality ((Kelly, J. F. (2017). Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavior change research. Addiction, 112(6), 929–936. https://doi.org/10.1111/add.13590)) and related practices as a new way of living.” Data has shown that this is an extremely effective way to approach recovery from alcohol abuse.

If faith-based recovery isn’t a good fit for you, there are a number of other support groups available, like SMART Recovery. ((Self-Help Addiction Recovery Program. (n.d.). Smart Recovery . https://www.smartrecovery.org/)) During SMART Recovery meetings, “participants find and develop the power within themselves to change and lead fulfilling and balanced lives.” Rather than following 12 predefined steps, each person creates their own personal plan for sustainable healing, and receives mutual emotional support from other members.

No matter which philosophy resonates with you, support groups can be helpful at every stage of recovery. Because most groups are free of charge, they are extremely accessible to people from all walks of life. And you can attend sessions as often as you need to; in many cities, it’s possible to find a different session for every day of the week.

This can help you meet new people in a healthy context. You’ll be able to join a community and learn valuable interpersonal skills. And by sharing this mutual support, you may gain insight into how to heal your relationships with people outside the group.

Healing Relationships From Alcohol Addiction

When you love someone with an AUD, it can be hard to know what to do. Before they get help, you may be called on to handle emergency situations, ranging from the inconvenient to the dangerous. And if the person is a close enough family member, you may feel obligated to help, no matter what it costs you.

There are a number of ways to help your loved one get into treatment. In extreme cases, you may even consider sending them to rehab involuntarily. ((Faq: Involuntary rehab – draft v1. (n.d.). Google Docs. Retrieved March 25, 2022, from https://docs.google.com/document/d/1-5xGTDuIQavxjnvFNvLdMkW_KIWBN40GWPQ5sQUzwCU/edit?usp=embed_facebook)) However, it’s important to remember that your needs matter, too. Whether or not they get help, you may need to heal from your own experiences of their addiction.

Some residential rehabs offer family programs, which may take place on-site or remotely. Depending on the specific facility, you might be able to participate in family therapy with a loved one in treatment, or you might even attend a group that’s only open to people outside the program. Either of these options may help you get the professional support you need, from a provider who understands the impact addiction can have on loved ones.

If your loved one doesn’t attend treatment, or if their rehab doesn’t have a family program, you might consider going to a free Al-Anon ((Scot. (n.d.). Al-anon family groups. Al-Anon Family Groups. Retrieved from https://al-anon.org/)) meeting. This 12-Step group is specifically designed for friends and family members of people with substance use disorders, including alcoholism.

Your personal healing process is different from that of healing your relationship. First, take some time to get support, center yourself, and learn how to meet your own needs. After that, you can start thinking about whether you want to work through things with your loved one.

Like any other type of recovery, this can be a complex and alinear process. Be patient with yourself—and with your loved one, if you decide to maintain the relationship. It’s okay to go slowly.

Life in Recovery from Alcohol Addiction

After you get treatment for alcohol abuse, life may look very different. Because alcohol is legal and widely available, it can be especially hard for people with AUDs to avoid triggering situations. Over time, though, you can learn when it’s appropriate to challenge yourself, and when you need to set firm boundaries. For example, you may be able to sit in a friend’s kitchen while they drink a glass of wine, even if you never feel comfortable going to a bar. There is no right or wrong way to proceed here; just the right or wrong way for you.

As you approach treatment and recovery, remember that it’s still possible to enjoy life. There are countless ways to have fun without drinking. Living healthily doesn’t just mean being sober; it also means learning how to enjoy yourself in a sustainable way.

If you or a loved one struggles with alcohol abuse, you can learn more about our rehab programs for alcohol addiction here.

Reviewed by Rajnandini Rathod

How to Approach Healing From Opioid Abuse

It’s all too easy to become addicted to opiates. Once you develop a tolerance for painkillers, it can be difficult to imagine life without them. This is true even for people who started by using opioids under medical supervision. And because they are so commonly prescribed, the misuse of these drugs is extremely prevalent. Because of this, there are many rehab programs for opioid use disorders.

It’s possible to use painkillers appropriately. For some patients, they can even be necessary. However, that’s not true for everyone. Opiate misuse can quickly become a vicious cycle. This is partly because these drugs not only impact brain chemistry; they also have an effect on physiology.

Chemical Effects of Opioid Use

Opioids are narcotics derived from the poppy plant, including heroin, morphine, codeine, fentanyl, methadone, tramadol, and more. Because these drugs can cause breathing difficulties, “opioid overdose ((Opioid overdose. (n.d.). Retrieved from https://www.who.int/news-room/fact-sheets/detail/opioid-overdose)) can lead to death.”

Opioids bind to the opioid receptors, which are located both in the brain and throughout the body. These receptors are involved in the experience of pleasure and pain. When any of these drugs, including illicit and prescription opioids, ((Abuse, N. I. on D. (2021, June 1). Prescription opioids drugfacts. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/prescription-opioids)) bind to these receptors, “they block pain signals sent from the brain to the body and release large amounts of dopamine throughout the body. This release can strongly reinforce the act of taking the drug, making the user want to repeat the experience.”

Experts are concerned that narcotics are overprescribed ((Mann, B. (2020, July 17). Doctors and dentists still flooding u. S. With opioid prescriptions. NPR. https://www.npr.org/2020/07/17/887590699/doctors-and-dentists-still-flooding-u-s-with-opioid-prescriptions)) for any type of acute or chronic physical pain. Because of this, opioids are widely available, even to people without their own prescriptions. And without proper medical supervision, these highly addictive drugs can have seriously harmful effects on a patient’s body, mind, and interpersonal relationships. The misuse of prescription opioids ((Lost in Translation: Does regular misuse of prescription opioids affect one’s ability to understand others’ emotions? (n.d.). Retrieved March 25, 2022, from https://www.recoveryanswers.org/research-post/lost-in-translation-does-regular-misuse/)) can cause “difficulty with memory and in reading certain types of emotions in other people, which they are unaware of.”

In addition, opiate misuse can lower a patient’s acute pain tolerance. ((Wachholtz, A., & Gonzalez, G. (2014). Co-morbid pain and opioid addiction: Long term effect of opioid maintenance on acute pain. Drug and Alcohol Dependence, 145, 143–149. https://doi.org/10.1016/j.drugalcdep.2014.10.010)) As you become more sensitive to pain, you may feel stronger urges to misuse painkillers, which results in an even lower tolerance. Although patients’ “tolerance to pain does appear to increase after the completion of treatment” for opiate use disorders, it’s hard to move past this addiction without help. And because of how easy it is to get caught in the cycle, opioid use disorders are so common, they are considered to be a national crisis in the U.S.

The Opiate Crisis

Opiate addiction often starts with the intention to treat pain. ((Treating opiate addiction, Part I: Detoxification and maintenance. (2005, April 1). Harvard Health. https://www.health.harvard.edu/mind-and-mood/treating-opiate-addiction-part-i-detoxification-and-maintenance)) And at one time, prescribing great quantities of narcotics was considered a best practice in the medical field. “During the 1990s, there was a push by public health officials to improve pain treatment in the United States. This led to pain becoming the ‘fifth vital sign.’ Doctors and nurses were given the impression that pain should be totally relieved. Narcotics are excellent pain relievers and too often they became the ‘go to’ treatment for pain. Although the public health effort was well intentioned, the consequences are now very well recognized. Overuse of prescription opioids has been a major contributor to the current ‘opioid epidemic.’”

The statistics of the opiate crisis ((Opioid crisis statistics [2022]: Prescription opiod abuse. (n.d.). NCDAS. Retrieved March 25, 2022, from https://drugabusestatistics.org/opioid-epidemic/)) paint a chilling picture. According to the National Center for Drug Abuse Statistics, over 10 million people misuse opiates every year. In that same time frame, nearly 50,000 people die from opiate overdoses. This class of drugs is a factor in 72% of all overdose deaths.

And the numbers are going up. “In 2020, more than 92,000 Americans died from drug overdoses, a nearly 30% increase over 2019.” If you suspect you may have an opiate use disorder, ((Opioid Use Disorder | psychiatry.org. (n.d.). Retrieved from https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder)) you don’t have to be part of that statistic.

Breaking the cycle is hard, but it is absolutely possible. Data suggests that many adults in the U.S. have recovered from opioid use disorders. ((Hoffman, L. A., Vilsaint, C., & Kelly, J. F. (2020). Recovery from opioid problems in the us population: Prevalence, pathways, and psychological well-being. Journal of Addiction Medicine, 14(3), 207–216. https://doi.org/10.1097/ADM.0000000000000561)) And for many patients, the process of recovery begins with detox.

Detoxing from Opiates

Detox can be physically dangerous. This is true for any substance, and especially for opiates. Because of this, it’s extremely important to undergo detox with proper medical supervision. Fortunately, doctors have many tools for withdrawal management. ((Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & Usa, 20894. (2009). Withdrawal management. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK310652/)) For example, your symptoms may be monitored using the Short Opiate Withdrawal Scale. This scale ranks patients symptoms, such as gastrointestinal distress, muscle spasms, aches and pains, etc., on a scale of zero to three. The severity of your symptoms will determine your eligibility for certain non-addictive medications.

Many patients benefit from medically-assisted treatment (MAT) for opiate detox and continued recovery. In this protocol, you may be prescribed medications such as clonidine, buprenorphine, or methadone. The latter is an especially common treatment for people in recovery.

Methadone Treatment for Opiate Use Disorders

Methadone is a synthetic opioid, and commonly used medication for opiate use disorders. ((Abuse, N. I. on D. (–). How do medications to treat opioid use disorder work? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work)) This drug “eliminates withdrawal symptoms and relieves drug cravings by acting on opioid receptors in the brain—the same receptors that other opioids such as heroin, morphine, and opioid pain medications activate. Although it occupies and activates these opioid receptors, it does so more slowly than other opioids and, in an opioid-dependent person, treatment doses do not produce euphoria. It has been used successfully for more than 40 years to treat opioid use disorder and must be dispensed through specialized opioid treatment programs.”

As effective as it can be for some patients, methadone is not an appropriate treatment for everyone. It may interact with other prescribed medications, causing heart conditions. Furthermore, its active ingredients remain in the body even after its noticeable effects wear off. Because of this, patients may unintentionally overdose if they fail to take methadone ((Methadone. (n.d.). Retrieved March 25, 2022, from https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone)) exactly as prescribed.

When used improperly, methadone can also become addictive. Despite this, it is often an effective treatment. The neurobiology of opioid use ((Kosten, T. R., & George, T. P. (2002). The neurobiology of opioid dependence: Implications for treatment. Science & Practice Perspectives, 1(1), 13–20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/)) is extremely complex, and it is absolutely essential for patients in recovery to stay in close communication with a medical team when using any prescribed alternative to narcotics.

Methadone treatment ((Methadone. (n.d.). Retrieved March 25, 2022, from https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone)) can take place in an inpatient or outpatient setting. If you’ve been cleared by a physician, you may even be able to take this drug by yourself, at home. However, this option will only become available after a period of stricter supervision.

Methadone may be prescribed for short-term use, or may help you navigate later stages of healing. Whether or not you plan to use this medication after your initial detox, it’s important to make a long-term plan for recovery.

Long-Term Treatment for Opioid Addiction

When you’re planning for life after detox, ((Life after detox: Can medication and residential treatment for opioid use disorder reduce risk of death? (n.d.). Recovery Research Institute. Retrieved January 24, 2022, from https://www.recoveryanswers.org/research-post/medication-residential-treatment-opioid-use-disorder-reduce-risk-death/)) it’s important to consider residential treatment. According to one study, medication and/or inpatient treatment have been “associated with reduced risk of death when compared to no treatment post detox” for people with opioid use disorders.

Various rehab programs offer different types of therapy. You may find that certain types of therapy resonate with you more than others, and this may change over time. Some experts believe that different treatments are appropriate at different stages of recovery from opiate addiction. ((Treating opiate addiction, Part II: Alternatives to maintenance. (2005, May 1). Harvard Health. https://www.health.harvard.edu/mind-and-mood/treating-opiate-addiction-part-ii-alternatives-to-maintenance)) For example, “psychotherapy may help at the pre-contemplation and contemplation stages, while cognitive and behavioral therapies may be more appropriate for the action and maintenance stages.” A few types of therapy can be especially helpful for patients recovering from opiate misuse.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment, or MAT, is a highly effective treatment for this condition. According to the National Institute on Drug Abuse (NIDA), MAT is an extremely important component of treatment for opiate use disorders. ((Abuse, N. I. on D. (–). How effective are medications to treat opioid use disorder? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder)) “Abundant evidence shows that methadone, buprenorphine, and naltrexone all reduce opioid use and opioid use disorder-related symptoms.”

Using prescribed substances to treat the misuse of other substances may seem counterintuitive. However, for these particular patients, psychotherapy and behavioral health treatment may be enough. In fact, research has found that medication can improve the outcomes of opiate use disorder treatment, ((Medications for opioid use disorder improve patient outcomes. (n.d.). Retrieved from https://pew.org/34ixgdT)) with or without the addition of talk therapy or behavioral therapy.

This data confirms the effectiveness of medical treatment for these patients. Regardless, patients in certain programs in the U.S. may be required to receive at least one form of counseling. According to federal law, patients who receive MAT for opiate use disorders ((Mat medications, counseling, and related conditions. (n.d.). Retrieved March 25, 2022, from https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions)) in accredited and certified opioid treatment programs (OTPs) “must receive counseling, which may include different forms of behavioral therapy. These services are required along with medical, vocational, educational, and other assessment and treatment services.”

Cognitive Behavior Therapy

Cognitive behavioral therapy (CBT) is a style of talk therapy in which the patient learns specific, practical skills for navigating difficult thought patterns. CBT is an effective treatment for substance use disorders ((McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive-behavioral therapy for substance use disorders. The Psychiatric Clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012)) in general, and opiate use disorders in particular.

CBT may be especially helpful for patients recovering from opioid use disorders ((Psychologists’ role in helping to treat opioid-use disorders and prevent overdoses. (n.d.). Https://Www.Apa.Org. Retrieved March 25, 2022, from https://www.apa.org/monitor/2017/04/ce-corner)) that began with the misuse of prescriptions for chronic pain. This is because CBT “may be used effectively to treat chronic pain, either as a stand-alone treatment or with other nonopioid pharmacological treatments. CBT improves pain-related outcomes along with mobility, quality of life, and disability and mood outcomes.” This data suggests that CBT may be an effective replacement for prescribed narcotics, whether or not the patient has a substance use disorder.

CBT has also been shown to increase the likelihood of long-term drug abstinence ((Psychologists’ role in helping to treat opioid-use disorders and prevent overdoses. (n.d.). Https://Www.Apa.Org. Retrieved from https://www.apa.org/monitor/2017/04/ce-corner)) for certain patients. In one study, “those in the CBT group had more than twice the mean number of weeks of drug abstinence compared with those who received medical management alone.” This treatment was found to be more effective for people who misused prescriptions than for those who used illicit opioids, like heroin.

Contingency Management

Contingency management (CM) ((Abuse, N. I. on D. (–). Contingency management interventions/motivational incentives(Alcohol, stimulants, opioids, marijuana, nicotine). National Institute on Drug Abuse. https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/contingency-management-interventions-motivational-incentives)) is a type of therapy that works well for patients who have misused any type of opioid. Some versions of CM, like voucher-based reinforcement, work especially well for recovering heroin users.

These programs involve “tangible rewards to reinforce positive behaviors such as abstinence.” ((Abuse, N. I. on D. (–). Contingency management interventions/motivational incentives(Alcohol, stimulants, opioids, marijuana, nicotine). National Institute on Drug Abuse. https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/contingency-management-interventions-motivational-incentives)) For example, a patient might receive a voucher every time they test negative for opioid use. These vouchers can then be exchanged for rewards such as food items, movie tickets, or other prizes. Some versions of CM reward patients with actual money.

It is important to combine contingency management with other forms of therapy, ((Bolívar, H. A., Klemperer, E. M., Coleman, S. R. M., DeSarno, M., Skelly, J. M., & Higgins, S. T. (2021). Contingency management for patients receiving medication for opioid use disorder: A systematic review and meta-analysis. JAMA Psychiatry, 78(10), 1092–1102. https://doi.org/10.1001/jamapsychiatry.2021.1969)) because “treatment effects often dissipate after contingency management is discontinued.” In order to achieve long-term recovery, patients should consider long-term treatment options such as talk therapy and support groups, such as 12-Step programs.

No single type of treatment is right for everyone. As you consider whether inpatient treatment is right for you, remember that there are many different options available. If you can, it’s best to talk to the admissions teams at a few facilities, and learn which types of therapy they offer.

Continued Recovery from Opiate Misuse

Recovering from an opiate use disorder is an extremely personal process. And healing isn’t always a straightforward path. But no matter what your experience has been so far, change is always possible.

As you start to plan for recovery, remember that you, too, deserve to heal. You deserve support and care. And with the right resources, you can begin to create a meaningful and sustainable life.

If you’d like to learn more about inpatient treatment, you can browse our list of rehabs for opioid use disorders here.

Reviewed by Rajnandini Rathod

Helpful Tools for Treating Marijuana Addiction

Marijuana addiction can be challenging to manage. If you’ve just arrived at this diagnosis, you probably have a lot of questions about what to do next. For some people, finding a rehab program that specializes in cannabis use disorder is a next step that makes sense.

Marijuana is the most widely consumed recreational drug in the world. Fortunately, there are many rehab centers and resources available for you to choose from.

Prevalence of Marijuana Addiction

You may be wondering if you really need a treatment as serious as rehab for something that’s generally not thought of as a “hard” drug. Is marijuana addiction real and something to be concerned about?

The answer is that yes, marijuanna addiction is real, even if it may look different than other kinds of substance addiction. And many people benefit from inpatient rehab, as well as other kinds of treatments.

Nearly 18% of people aged 12 or older reported that they had used cannabis in the past year. About 5% of people in the U.S. (or about 14.2 million people) had cannabis use disorder symptoms ((Abuse, N. I. on D. (–). What is the scope of cannabis (Marijuana) use in the United States? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/marijuana/what-scope-marijuana-use-in-united-states)) in the past 12 months.

The main chemical in marijuana that produces most of its psychoactive (mind-altering) effects is delta-9-tetrahydrocannabinol (THC). Over the years, cannabis has become much more potent, ((Abuse, N. I. on D. (–). Is marijuana addictive? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/marijuana/marijuana-addictive)) and this may complicate your attempts to stop or decrease how much you use.

Legalization of medical cannabis in the U.S. has made it easier to know how much THC you’re ingesting. Legalization has also played a role in shifting the consequences for using cannabis, and how easy it is to access it.

Because of these considerations, your marijuana use may have negative effects on your life even while you’re doing your best to manage it. The good news is that professionals have developed an understanding of what you’re experiencing and how to best support you.

Risk Factors for Marijuana Addiction

Certain demographics have a heightened vulnerability to marijuana misuse. ((Hasin, D. S., Kerridge, B. T., Saha, T. D., Huang, B., Pickering, R., Smith, S. M., Jung, J., Zhang, H., & Grant, B. F. (2016). Prevalence and correlates of dsm-5 cannabis use disorder, 2012-2013: Findings from the national epidemiologic survey on alcohol and related conditions–iii. American Journal of Psychiatry, 173(6), 588–599. https://doi.org/10.1176/appi.ajp.2015.15070907)) For example, people who start using marijuana before the age of 18 ((Abuse, N. I. on D. (–). Is marijuana addictive? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/marijuana/marijuana-addictive)) are four to seven times more likely to develop a marijuana use disorder than people who start at a later age.

More and more older adults are using marijuana and need support for cannabis use disorder, ((Choi, N. G., & DiNitto, D. M. (2019). Older marijuana users in substance abuse treatment: Treatment settings for marijuana-only versus polysubstance use admissions. Journal of substance abuse treatment, 105, 28-36.)) along with other substance use issues.

Additional risk factors for cannabis use disorder  include having a mental health diagnosis like anxiety or depression, as well as the following:

  • family history
  • peer pressure
  • loneliness or social isolation
  • lack of family involvement
  • drug availability

The Impact of Marijuana Addiction

Many people use marijuana without issue, but it’s important to notice whether it’s negatively affecting your life. There are short- and long-term consequences for using marijuana.

Immediate Effects

“Instead of relaxation and euphoria, some people experience anxiety, fear, distrust, or panic” ((Abuse, N. I. on D. (–). What are marijuana’s effects? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/marijuana/what-are-marijuana-effects)) when using marijuana, according to the National Institute on Drug Abuse (NIDA).

“These effects are more common when a person takes too much, the marijuana has an unexpectedly high potency, or the person is inexperienced. People who have taken large doses of marijuana may experience an acute psychosis, which includes hallucinations, delusions, and a loss of the sense of personal identity,” says NIDA.

Dependence

Marijuana dependence ((Abuse, N. I. on D. (–). Is marijuana addictive? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/marijuana/marijuana-addictive)) happens when your brain adapts to large amounts of the drug by reducing production of, and sensitivity to, its own endocannabinoid neurotransmitters.

People who use marijuana frequently often report irritability, mood and sleep difficulties, decreased appetite, cravings, restlessness, or physical discomfort. These effects peak within the first week after quitting and last up to 2 weeks.

Cannabis Use Disorder Symptoms

The diagnosis that used to be named cannabis addiction has been changed to cannabis use disorder. Symptoms of cannabis use disorder include the following:

  • using more marijuana than intended
  • trying but failing to quit using marijuana
  • spending a lot of time using marijuana
  • craving marijuana
  • using marijuana even though it causes problems at home, school, or work
  • continuing to use marijuana despite social or relationship problems
  • giving up important activities with friends and family in favor of using marijuana
  • using marijuana in high-risk situations, such as while driving a car
  • continuing to use marijuana despite physical or psychological problems
  • needing to use more marijuana to get the same high
  • experiencing withdrawal symptoms when stopping marijuana use

In withdrawal, you might experience irritability, nervousness, difficulties with sleep, restlessness, depressed mood, stomach pains, chills, and headaches. For some people, cannabis withdrawals cause unpleasant, vivid dreams and notice changes in their appetite. ((Hesse, M., & Thylstrup, B. (2013). Time-course of the DSM-5 cannabis withdrawal symptoms in poly-substance abusers. BMC Psychiatry, 13(1), 258. https://doi.org/10.1186/1471-244X-13-258))

Long-term Effects

Over time, there’s a possibility that you’ll experience problems with attention, memory, and learning related to marijuana misuse.

Beginning to acknowledge the impacts of substance use on the rest of your life can feel challenging. Remember that you deserve care and support in that process. And it’s heartening to remember that available treatments are specifically designed to support you in changing your marijuana use in the way that’s most helpful for you.

Marijuana Addiction, Other Substance Use Disorders, and Mental Health

Cannabis use disorder is associated with other diagnoses, ((Hasin, D. S., Kerridge, B. T., Saha, T. D., Huang, B., Pickering, R., Smith, S. M., Jung, J., Zhang, H., & Grant, B. F. (2016). Prevalence and correlates of dsm-5 cannabis use disorder, 2012-2013: Findings from the national epidemiologic survey on alcohol and related conditions–iii. American Journal of Psychiatry, 173(6), 588–599. https://doi.org/10.1176/appi.ajp.2015.15070907)) including mood disorders like depression and anxiety, personality disorders, and other substance use disorders. This means that lots of people who seek help for substance use have co-occurring disorders.

Is Marijuana a Gateway Drug?

People who used marijuana and already had an alcohol use disorder may be at greater risk of their alcohol use disorder getting worse. Marijuana use is also linked to other substance use disorders including nicotine addiction.

But most people who use marijuana don’t go on to use other, “harder” substances. ((Abuse, N. I. on D. (–). Is marijuana a gateway drug? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/marijuana/marijuana-gateway-drug)) In fact, cross-sensitization is not unique to marijuana. What this means is that substances like alcohol and nicotine also prime the brain to have a greater response to other drugs. This isn’t something that’s the case for marijuana specifically.

Marijuana and Risk of Psychosis

Cannabis-induced psychosis is a concern, particularly if you have a genetic predisposition to the experience, schizophrenia and other psychiatric diagnoses, or different types of vulnerabilities.

According to a group of researchers in the Department of Psychosis Studies at King’s College London, people who use marijuana and carry a specific variant of the AKT1 gene are at increased risk of developing psychosis. People with the AKT1 gene who used marijuana daily were 7 times more likely to develop psychosis than people who used marijuana infrequently or not at all.

Another study found elevated levels of psychosis among adults who had used marijuana in adolescence and also carried a specific variant of the gene for catechol-O-methyltransferase (COMT).

If you’re struggling with your relationship with marijuana and also experiencing mental health challenges or problems with another substance, there are a number of rehab programs and treatment approaches that are tailored to your unique needs.

Treatments for Marijuana Addiction

Why reduce or stop using cannabis? In one study, participants reported that they had 3 main reasons for decreasing or stopping their marijuana use: ((Stea, J. N., Yakovenko, I., & Hodgins, D. C. (2015). Recovery from cannabis use disorders: Abstinence versus moderation and treatment-assisted recovery versus natural recovery. Psychology of Addictive Behaviors, 29(3), 522.))

  1. Self-incompatibility: Using marijuana wasn’t in line with their values and life goals.
  2. Social incompatibility: Friends and family held values that weren’t consistent with marijuana use.
  3. Mental health concerns: Using marijuana caused or worsened their depression or anxiety.

Maybe these reasons resonate with you too, or maybe you have different reasons for wanting to make a change. Science supports the efficacy of certain treatments for this condition.

Something to keep in mind: in one study that focused on outcomes of marijuana use treatment, interventions for cannabis use disorder ((Gates, P. J., Sabioni, P., Copeland, J., Foll, B. L., & Gowing, L. (2016). Psychosocial interventions for cannabis use disorder. Cochrane Database of Systematic Reviews, 5. https://doi.org/10.1002/14651858.CD005336.pub4)) had the best short-term effectiveness when they lasted more than 4 sessions and over a month’s time, as compared to more brief, lower‐intensity interventions.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy for cannabis use disorder ((Litt, M. D., Kadden, R. M., Tennen, H., & Petry, N. M. (2020). Individualized assessment and treatment program (Iatp) for cannabis use disorder: Randomized controlled trial with and without contingency management. Psychology of Addictive Behaviors : Journal of the Society of Psychologists in Addictive Behaviors, 34(1), 40–51. https://doi.org/10.1037/adb0000491)) “targets the (perceived) functional role that cannabis use plays in a patient’s life and seeks to alter the cognitive and behavioral mechanisms precipitating use. Patients are taught skills to aid cannabis reduction/cessation and maintain this change. This could involve, for example, teaching patients to identify situations likely to trigger motivation to cannabis use and how to avoid them, or how to address the thoughts and emotions underlying the motivation to use.

“Other components of CBT include building drug refusal skills and problem-solving skills, and making healthy lifestyle modifications. The main goals of CBT are to increase patient self-efficacy to resist cannabis use and expand their repertoire of coping skills.”

An individualized approach to treatment planning may increase effectiveness of CBT for marijuana use treatment. ((Litt, M. D., Kadden, R. M., Tennen, H., & Petry, N. M. (2020). Individualized assessment and treatment program (Iatp) for cannabis use disorder: Randomized controlled trial with and without contingency management. Psychology of Addictive Behaviors : Journal of the Society of Psychologists in Addictive Behaviors, 34(1), 40–51. https://doi.org/10.1037/adb0000491)) It involves using your thoughts, feelings, and behaviors to identify what situations put you at the highest chance for relapse.

To learn more about this approach, see our list of rehabs that offer individualized treatment for marijuana addiction.

Motivational Enhancement Therapy

Motivational enhancement therapy for cannabis use disorder ((Gates, P. J., Sabioni, P., Copeland, J., Foll, B. L., & Gowing, L. (2016). Psychosocial interventions for cannabis use disorder. Cochrane Database of Systematic Reviews, 5. https://doi.org/10.1002/14651858.CD005336.pub4)) is set up to mobilize your internal resources to help you make change and engage fully in treatment. This approach gives you a space to explore feelings of resistance that may be coming up, and strengthen your sense of self-efficacy.

Rational Emotive Behavior Therapy

In rational emotive behavior therapy, ((Ellis, A., & MacLaren, C. (2008). Rational emotive behavior therapy. The quick theory reference guide: A resource for expert and novice mental health professionals, 127-139.)) the therapist works through a set of target problems with you and helps you decide on your goals for the course of treatment. You work together to discover emotions, behaviors, and beliefs related to those problems based on your values and goals. The goal is for you to apply what you learn in session to real-life situations.

Contingency Management

Contingency management ((Litt, M. D., Kadden, R. M., Tennen, H., & Petry, N. M. (2020). Individualized assessment and treatment program (Iatp) for cannabis use disorder: Randomized controlled trial with and without contingency management. Psychology of Addictive Behaviors : Journal of the Society of Psychologists in Addictive Behaviors, 34(1), 40–51. https://doi.org/10.1037/adb0000491)) is an approach that allows you to track how often you use marijuana and compare that to a goal. Based on whether or not you use marijuana each day or week, you either earn rewards, or they are removed. During future days, you have more chances to keep earning rewards.

Parent involvement in contingency management ((Contingency management + parent participation = further benefits to adolescents? (n.d.). Recovery Research Institute. Retrieved March 1, 2022, from https://www.recoveryanswers.org/research-post/contingency-management-parent-participation-further-benefits-to-adolescents/)) procedures can also be helpful for teens who are trying to reduce or stop their marijuana use.

Community-Based Strategies

Your substance use, and positive changes you make, happen within your environment. A community-based strategy approach uses support strategies such as celebratory events, involving people in decision-making, and building available resources.

Medication Interventions

Currently, the FDA hasn’t approved any medications to treat cannabis use disorder, but research is active in this area.

Some medication-based treatments for marijuana addiction ((Abuse, N. I. on D. (–). Available treatments for marijuana use disorders. National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/marijuana/available-treatments-marijuana-use-disorders)) target sleep issues, a big part of marijuana withdrawal. “Medications that have shown promise in early studies or small clinical trials include the sleep aid zolpidem (Ambien®), an anti-anxiety/anti-stress medication called buspirone (BuSpar®), and an anti-epileptic medication called gabapentin (Horizant®, Neurontin®) that may improve sleep and, possibly, executive function.”

In addition, THC, antidepressants, buspirone, N-acetylcystine, and mood stabilizers have been studied, and may be helpful in some cases. However, they may not be significantly more effective than a placebo. ((Nielsen, S., Gowing, L., Sabioni, P., & Le Foll, B. (2019). Pharmacotherapies for cannabis dependence. Cochrane Database of Systematic Reviews, (1).))

Finding a treatment that works well for you is possible. By making changes at the psychological, physical, or community level, you open up the possibility for new patterns of behavior.

Long-Term Recovery from Marijuana Addiction

What to Expect in Recovery

There are positive changes that start to happen after you reduce or stop using marijuna. For example, young people between the ages of 16 and 26 showed increased performance on sustained attention tasks after stopping their cannabis use ((Wallace, A. L., Wade, N. E., & Lisdahl, K. M. (2020). Impact of two-weeks of monitored abstinence on cognition in adolescent and young adult cannabis users. Journal of the International Neuropsychological Society : JINS, 26(8), 776–784. https://doi.org/10.1017/S1355617720000260)) for 2 weeks.

Participants in another study showed improvements in memory after 1 month of not using marijuana. ((Schuster, R. M., Gilman, J., Schoenfeld, D., Evenden, J., Hareli, M., Ulysse, C., Nip, E., Hanly, A., Zhang, H., & Evins, A. E. (2018). One month of cannabis abstinence in adolescents and young adults is associated with improved memory. The Journal of Clinical Psychiatry, 79(6), 17m11977. https://doi.org/10.4088/JCP.17m11977)) Treatment of cannabis use disorder also improves depressive symptoms ((Arias, A. J., Hammond, C. J., Burleson, J. A., Kaminer, Y., Feinn, R., Curry, J. F., & Dennis, M. L. (2020). Temporal dynamics of the relationship between change in depressive symptoms and cannabis use in adolescents receiving psychosocial treatment for cannabis use disorder. Journal of Substance Abuse Treatment, 117, 108087. https://doi.org/10.1016/j.jsat.2020.108087)) in adolescents.

Setting Yourself up for Success

Once you’re better able to manage your cannabis use, it’s important to arrange your environment to make yourself as successful as possible.

In one study, participants shared 3 main helpful strategies for maintaining their change of stopping or decreasing their marijuana use: ((Stea, J. N., Yakovenko, I., & Hodgins, D. C. (2015). Recovery from cannabis use disorders: Abstinence versus moderation and treatment-assisted recovery versus natural recovery. Psychology of Addictive Behaviors, 29(3), 522.))

  1. Cognitive strategies: They weighed the benefits and costs of use, identifying reasons that cannabis use might be incompatible with their goals and values, and also identifying the mental health consequences of use.
  2. Social shifts: They spent less time with marijuana users and more time with non users.
  3. Stimulus control/avoidance: They spent less time at places and in situations that used to be associated with cannabis use, and more time on new hobbies and in places where wellness is emphasized, like the gym.

Making a Positive Change

Navigating substance misuse can be difficult. Your journey up to now is unique and the support you receive should make sense for you.

Many rehab programs offer specialized programs to help you change your relationship with marijuana and build new habits. Taking the next step is possible, and there are lots of tools available to help you find stability and hope.

If you want to learn more about programs that treat this issue, you can browse our list of rehabs that treat marijuana addiction here.

Trauma-Informed Care: Finding Support and Understanding in Rehab

Trauma often changes how you interpret the world—and it’s easy to feel that no one understands. But it’s a rather common human experience: “70% of adults in the U.S. experienced some type of traumatic event ((2013. How to Manage Trauma. National Council for Behavioral Health, pp.1-2. Retreived from https://www.thenationalcouncil.org/wp-content/uploads/2013/05/Trauma-infographic.pdf?daf=375ateTbd56)) at least once in their lives,” according to the National Council for Behavioral Health.

Given how prevalent trauma is, the need to properly address it is growing increasingly important in the behavioral health services field. Treatment providers that take a trauma-informed approach to care acknowledge that trauma exists and emphasize a treatment setting that promotes safety, fosters trust, and prevents re-traumatization.

When trauma affects your life, it might be hard to foresee a path to recovery. Receiving knowledgeable, empathetic, trauma-informed care can be the start of a new chapter in leading a happier and more productive life.

What Is Trauma-Informed Care?

Trauma-informed care (TIC) is an approach ((What is trauma-informed care? (n.d.). Retrieved February 28, 2022, from https://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/what-is-trauma-informed-care.html)) in the health and human services field that recognizes the role trauma plays in someone’s life. It calls for empathy and awareness of an individual’s trauma and ways to address it in order to deliver care as effectively as possible.

Clinical Instructor at Harvard Medical School Dr. Monique Tello, MD, MPH, explains: “The first step is to recognize how common trauma is and to understand that every patient may have experienced serious trauma. ((MPH, M. T., MD. (2018, October 16). Trauma-informed care: What it is, and why it’s important. Harvard Health. https://www.health.harvard.edu/blog/trauma-informed-care-what-it-is-and-why-its-important-2018101613562)) We don’t necessarily need to question people about their experiences; rather, we should just assume that they may have this history and act accordingly…Trauma-informed care is the open-mindedness and compassion that all patients deserve, because anyone can have a history that impacts their encounter with the medical system.”

For many people, trauma is a barrier to seeking addiction treatment. ((Juliana, E., 2021. Trauma Barriers to Substance Abuse Treatment Engagement Among Formerly Incarcerated Males. Walden University.)) In some cases, a patient has already received treatment in which trauma wasn’t properly addressed, causing retraumatization. The aim of TIC is to reduce these blocks and provide services in an accessible and appropriate manner.

What Does Trauma-Informed Care Involve?

6 key principles of trauma-informed care ((2014. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. [ebook] Substance Abuse and Mental Health Services Administration. Available at: https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf)) inform how treatment professionals interact with their clients:

1. Safety

Everyone in the treatment facility, including patients and staff, should feel physically and emotionally safe.

2. Trustworthiness and Transparency

Transparency is emphasized throughout the organization, with the objective of promoting and maintaining trust among staff, patients, and their family members.

3. Peer Support

The term “peers” in a trauma-informed setting refers to individuals who have lived experiences of trauma. Peers play an important role in trauma-informed care. They can help develop trust, provide a sense of safety, and empower others through their stories of shared experiences to promote recovery and healing.

4. Collaboration and Mutuality

This principle acknowledges that “one does not have to be a therapist to be therapeutic.” ((2014. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. [ebook] Substance Abuse and Mental Health Services Administration. Available at: https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf)) Everyone has an equal role to play in a trauma-informed approach, whether you’re a patient, therapist, or support staff member.

5. Empowerment, Voice, and Choice

The treatment provider honors the strength, resilience, and ability of everyone involved in promoting recovery. Empowerment throughout the organization is key. Staff are trusted to deliver their best work and clients are empowered with choice and decision-making. Staff members serve as facilitators, rather than controllers, of rehabilitation.

6. Cultural, Historical, and Gender Issues

The organization deliberately pushes past cultural prejudices and biases in order to provide culturally sensitive treatments, identify and resolve historical trauma, and maximize the healing benefits of traditional cultural relationships.

A trauma-informed care approach is not accomplished through any single particular technique or checklist. It requires constant attention, caring awareness, sensitivity, and possibly a cultural change at an organizational level.” A quality treatment provider will continually assess their trauma-informed approach and make improvements when necessary.

What Are the Advantages of a Trauma-Informed Care Program?

Trauma-informed care isn’t considered a form of therapy. Instead, it’s an approach that guides how providers deliver your care. Providers that are trauma-informed apply an empathetic understanding of trauma to all areas of treatment.
Consistently applying a trauma-informed approach offers several key benefits: ((Maul, A. and Menschner, C., 2016. Key Ingredients for Successful Trauma-Informed Care Implementation. [PDF] Center for Health Care Strategies, pp.1-12. Available at: https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf))

Establishes a Safe and Secure Environment

One of the hallmarks of trauma-informed care is providing a sense of safety throughout. You should feel physically and emotionally secure in any location in the facility. Feeling safe not only avoids retraumatization, but can help you be more present and comfortable while participating in your treatment program.

Facilitates Peer Support

People often feel isolated and alone in their struggles following a traumatic event. Trauma-informed care brings together individuals who’ve had similar experiences, creating opportunities for mutual support. This is helpful for several reasons. Seeing the positive impact of sharing your experiences with others can give you a sense of purpose. And listening to what others have gone through provides assurance that you’re not alone; others are by your side on the journey towards recovery.

Promotes Empowerment

In traditional treatment settings, clinicians may decide on a treatment with little opportunity for patient feedback. But in trauma-informed treatment, collaboration is key to patient empowerment. Rather than a doctor or therapist telling you what you should or shouldn’t do, patients have a say in their own therapy and play an active part in decision-making. This satisfies the 5th guiding principle of trauma-informed care: giving clients a voice in treatment. Feeling ownership of your treatment process can be a strong catalyst for following through and getting the most out of your time in therapy.

Avoids Retraumatization

At times, well-intentioned care providers can retraumatize trauma survivors. Forcing people to relive their traumas or pressuring them to open up can cause retraumatization. People are less likely to seek mental health and addiction treatment if they’ve experienced retraumatization. An important goal of trauma-informed care is to prevent this from happening.

How Might Treatment Providers Apply a Trauma-Informed Approach in Practice?

We’ve discussed the essential principles involved in trauma-informed care, but how might providers put these into action? Essentially, patients should feel physically and emotionally safe from the moment they arrive.

Physical Safety

Signs that a provider is taking steps to help you feel physically safe include having well-lit parking and common areas, security personnel to monitor who’s entering and exiting the building, a comfortable waiting area, minimized loud noises, and more.

Emotional Safety

Providers that practice TIC also take your feelings of emotional safety into account. They understand that going into an unfamiliar environment to receive treatment can feel intimidating, and create a sense of safety through communication. Communication follows a pattern of support and affirms a relationship of respect and partnership between you and your treatment team.

This can apply to scheduling as well. Because unexpected changes may be jarring for some, your team may aim to keep your schedule consistent and communicate any necessary changes in advance.

Mental health professionals often need to ask personal questions. In a trauma-safe context, they might explain what they’re about to ask and why it’s necessary. This same concept applies to physical exams. You should be told ahead of time why the examination is needed and what it will involve. You’re free to say “stop” at any time. This helps ensure your boundaries are respected. Your providers should always respect your humanity and treat you with compassion, and never compel you to endure something you’re not comfortable with.

Screening for Trauma

Trauma screening is a key component of trauma-informed care. Different providers have their own opinions on when to deliver a screening. But the general consensus in the behavioral health field is that trauma screening should come after you’ve built up trust with your provider. When you initially contact a treatment facility, they tend to avoid asking about specific trauma until you’ve established a connection with someone from their team.

Providers are expected to be trained in trauma screening so they can offer the appropriate follow-up care and avoid re-screening patients. Part of this training includes sensitivity to cultural and ethnic issues.

Staff are Trained in Trauma-Specific Therapies

If a provider practices trauma-informed care, their team should be trained in trauma-specific therapies. There are a wide range of therapies that address different types of trauma. Common therapies include trauma-focused cognitive-behavioral therapy (TF-CBT), eye movement desensitization and reprocessing (EMDR), and exposure therapy.

Can Triggers Be Completely Avoided?

Triggers are taken into account in trauma-informed care. A trigger is an incident that produces a strong emotional response. The reaction may seem out of proportion to your current situation, but would be a normal response to the trauma you’ve experienced.

Having triggers doesn’t mean you’re weak or overly sensitive. We all have certain natural reactions to perceived threats. These reactions can serve us well when they drive us to act with urgency at the right time. But if the reactions are involuntary and disproportionate to your current circumstances, it can disrupt your way of life. The time and effort spent on treatment at a trauma-informed rehab can help you regain a measure of control.

Everyone’s triggers are different, and sometimes they can be difficult to anticipate. For example, you may have a strong emotional reaction around the anniversary date of a traumatic experience. The scent of a certain perfume may trigger unexpected anxiety, or hearing the song that played on the radio when you were in a car accident may cause unexpected panic.

It’s unrealistic and unproductive to try to avoid all triggers. Even if you never listen to the radio at home, the song you heard during the car accident might start playing in the car next to you at a red light. Making efforts to avoid triggers is an understandable temporary strategy. But the long-term purpose of trauma-specific therapies delivered in this setting isn’t to shield you from triggers. Instead, you’ll learn how to control your emotions and cope with distressing episodes.

Trauma-Informed Care: An Opportunity for Positive Results

Many complex issues are considered in trauma-informed care, and rightfully so. Access to safe, empowering, understanding interactions with others is instrumental in the healing process.

Some people avoid getting mental health or addiction treatment because they’re concerned about being forced to endure uncomfortable situations. A trauma-informed approach to recovery can help to change the negative connotations of participating in therapy. Quality providers recognize how trauma impacts feelings and behaviors, and apply this knowledge throughout their organization with the goal of providing a better experience for you and their team. Getting the support and understanding you deserve can open the door to more positive experiences in rehab.

Browse our list of rehabs that address trauma to learn more.

Finding Treatment for Eating Disorders

Eating disorders (EDs) are a serious mental health issue. And while they’re more common than you might think, it’s important to remember that eating disorders are treatable. People can and do recover from them.

Treatment for eating disorders comes in several forms: some people need, or prefer, to receive around-the-clock care from medical professionals and will opt for a residential rehab program. For those with a strong support network, an outpatient program may be a good fit. Eating disorders are complex, so one type of treatment isn’t necessarily better than the other. Here, we’ll guide you through the basics of eating disorders, along with different treatment options and common therapies:

  • What’s an Eating Disorder?
  • Signs and Symptoms
  • Types of Eating Disorders: An Overview
  • Common Causes of Eating Disorders
  • Who Suffers from Eating Disorders?
  • Where to Find Treatment
  • Common Therapies for Eating Disorders

What’s an Eating Disorder?

The American Psychological Association defines eating disorders1 as any “abnormal eating habit that can threaten your health or even your life.” People who suffer from eating disorders may eat less or more than the recommended amount of food to be considered healthy. An estimated 30 million U.S. adults will have experienced some form of eating disorder2 at some point in their lives.

Eating disorders are serious mental health conditions that present both behavioral and physical symptoms.

Signs and Symptoms

When you seek professional help for an eating disorder, your healthcare provider must give you a formal diagnosis before mapping out a treatment plan. They’ll look at your feeding and eating disorder symptoms3 as laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There are several different types of eating disorders defined in DSM-5, and each is distinct from the other. Some symptoms may apply to many of these disorders:

Behavioral Symptoms

  • Excessively preoccupied with thoughts of food and body shape or image, making it difficult to focus on other areas of life
  • Restricting calorie intake or refusing to eat certain foods like carbohydrates
  • Engaging in compulsive eating habits like skipping meals, episodes of out-of-control eating, self-induced vomiting or over-exercising
  • Anxious about eating around others
  • Withdrawing from social contact and your usual hobbies
  • Irritability or mood swings
  • Hiding eating behaviors

Physical Symptoms:

  • Noticeable weight fluctuations
  • Dizziness or feeling lightheaded, commonly exacerbated by movement
  • Digestive issues such as constipation, stomach cramps, bloating, and more
  • Females may experience irregular periods or periods may stop completely
  • Dental issues including cavities, sensitive teeth, and enamel erosion
  • Muscle weakness

Types of Eating Disorders: An Overview

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists several different types of eating disorders:

  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
  • Avoidant/restrictive intake disorder
  • Pica
  • Rumination disorder
  • Other specified feeding and eating disorders (OSFED) including:
    1. Muscle dysmorphia
    2. Orthorexia nervosa (ON) proposed criteria

People most commonly seek treatment for anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Anorexia Nervosa

If you suffer from anorexia nervosa, you may experience intense feelings of self-consciousness and body image distortion, causing you to withhold food from yourself. People with anorexia often engage in extreme eating habits to lose weight. If you notice signs of anorexia, don’t take it lightly. Anorexia is one of the most fatal mental health issues4 in the U.S., with an estimated mortality rate of 10%.

Bulimia Nervosa

Bulimia nervosa is characterized by episodes of binge-eating followed by attempts to “purge” the food over the fear of gaining weight. People may attempt to “purge” through vomiting, laxatives, or over-exercising, all of which are harmful to the body.

Binge-Eating Disorder

Those with a binge-eating disorder experience recurring, vicious cycles of uncontrollable overeating. People often cite a loss of control during binge-eating episodes5. While everyone’s trigger for binge eating is different, it’s usually associated with high stress.

Common Causes of Eating Disorders

The exact cause of eating disorders is still inconclusive. However, there are several speculated risk factors that contribute to the development of eating disorders6.

Biological Factors
A significant number of medical studies suggest an association between genetics and eating disorders. A 2004 report detailing the genetics of eating disorders published in Psychiatry (Egmond) found “greater than 50% of the variance in liability to eating disorders and disordered eating behaviors can be accounted for by additive genetic effects.”7 More recently in 2013, the Annals of Neurosciences reported an “undeniable link between genetic factors and eating disorders.”8

Environmental Factors
A unique combination of environmental factors can contribute to body dissatisfaction. These might include societal pressure and other environmental influences like bullying in school, criticism from family members, and the idolization of certain body types. Teens and young adults are especially impressionable: body dissatisfaction among American teens9 reached new highs in the wake of the Covid-19 pandemic.

Trauma
The flood of emotions that follow a traumatic event can trigger an eating disorder, and it’s rather common for eating disorder patients to cite traumatic experiences. According to a study published in Eating Disorders The Journal of Treatment & Prevention, researchers found that “the prevalence of traumatic events in ED patients10 has ranged from 37% to 100%.”

Co-occurring Disorders
Eating disorders are a mental health issue that commonly co-occurs with other mental disorders. The National Association of Anorexia Nervosa and Associated Disorders reports that between 33% up to 50% of individuals with anorexia have co-occurring mood disorders11, like anxiety and depression.

Who Suffers from Eating Disorders?

Eating disorders can affect anyone regardless of gender, ethnicity, and age.

The American Psychological Association estimates that in the U.S., 20 million women and 10 million men will experience some form of eating disorder1 in their lives. While women are more likely to receive a diagnosis than men, the number of men who suffer from an eating disorder may be under-reported12. That may be because men aren’t as likely to seek treatment.

Eating disorders are more common among teenagers and young adult populations. According to the National Institute of Mental Health13, people normally start developing bulimia and anorexia at the age of 18, and 21 for binge eating. But eating disorders can still affect the elderly. Unfortunately, this is sometimes overlooked. A 2012 study published in the International Journal of Eating Disorders found that 13% of women in the U.S. aged 50 and older have eating disorder symptoms14.

Where to Find Treatment

If you think you or a loved one has an eating disorder, the earlier you find help the better. Untreated eating disorders can have serious and harmful effects on the body. In severe cases, eating disorders can be fatal. For example, the mortality rate for people who suffer from anorexia is 18 times higher15 than for individuals who don’t have eating disorders.

Many people start their recovery journey by talking to their primary care physician. They’ll begin by checking your medical history and vital signs to ensure you don’t need more serious care, like medication or hospitalization. If your case doesn’t require hospitalization, your physician may be able to point you towards local resources for treating eating disorders, like a dietician, therapist, or outpatient program.

There are several levels of care for treating eating disorders. Each varies in intensity and is delivered in different settings.

Inpatient Programs (Residential Rehab)

In an inpatient program, you receive 24/7 clinical care on-site at a treatment center. This is the most intensive level of care and is usually recommended if patients exhibit worrying medical signs:

      • laboratory findings that are abnormal or indicate critical health risks
      • unstable vital signs including cardiac disturbances, hypothermia, hypotension, and more
      • coexisting medical conditions that may result in further complications

You don’t need to have severe medical issues to enroll in an inpatient program. For some people, a change of scenery and stepping away from potential triggers is exactly what they need to successfully work towards long-term recovery.

Partial Hospitalization Program (PHP)

A PHP, also referred to as a “day hospital,” is less intensive than an inpatient program but more intensive than an IOP. In a PHP, you receive treatment at a clinic for around 3 to 5 days each week, 4 to 8 hours a day. You’ll go home each day after treatment.

Intensive Outpatient Program (IOP)

While outpatient programs still follow an intensive therapeutic schedule, you can go home each day after treatment rather than receive 24-hour medical monitoring. You can expect to go in for treatment 3 to 5 hours a day, around 2 to 3 days each week.

This option can work for people who have their symptoms under control enough to complete daily tasks. It’s also usually more cost-effective than inpatient programs. IOPs may be a good fit for people who have a strong support network at home.

Support Groups

Eating disorder support groups offer a network of peers who share similar experiences to yours and some provide educational information that could aid your recovery. There are two main types of support groups: self-help support groups and professionally operated support groups.

Self-help groups, also called “fellowships” or “peer support groups,” are organized by members of the group itself. The sense of comradery this creates can be important for many people in their recovery journey.

Professionally operated support groups are facilitated by professionals like a licensed therapist or a social worker. On top of offering a strong support network of peers, group discussions are led by staff with professional experience in the field of eating disorder treatment. These groups are often operated by hospitals, clinics, or treatment centers and may require a fee to attend.

Searching for Treatment Online

Most people turn to the internet to find eating disorder treatment programs. For the most part, quality treatment centers have their patients’ best interests at heart and help many find recovery each year. But some centers engage in ethically questionable practices. It’s important to be wary of these exploitative practices to protect yourself from rehab scams, which unfortunately do exist.

You can take extra precautionary steps to protect yourself from potential illegitimate rehabs when searching for eating disorder treatment online:

      • Be wary of free helplines. Some websites may present information that appears unbiased, but require you to call a hotline. In some cases, these hotlines connect you with an agent who receives a referral fee for placing someone in a specific treatment center or program.
      • Get your questions answered. During your call with any treatment provider, make sure their admissions team can answer specific questions you may have about their center and program. Be cautious if their answers seem vague, or they can’t specify details about their program.
      • Ask about referral fees. If your primary care provider recommends a treatment facility, you can be upfront with them and politely ask if they received any compensation for making the recommendation.

Common Therapies for Eating Disorders

Since each individual’s experience with eating disorders is unique, there’s no universal approach to healing. Treatment usually involves steps to get back to a healthy weight and normalize bodily functioning, as well as psychotherapy to address the mental issues that eating disorders can stem from.

Nutritional Counseling

Dietitians or nutritionists who specialize in eating disorders work to understand the nutritional needs and challenges of their patients. From there, they’ll design a plan to help them safely meet those needs. One of their goals is to restore weight to a healthy level. According to The American Dietetic Association, “Medical Nutrition Therapy provided by a registered dietitian trained in the area of eating disorders16 plays a significant role in the treatment and management of eating disorders.”

Psychotherapy

There are several different kinds of psychotherapy (also known as “talk therapy”) used to treat eating disorders. Some common ones include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and family therapy.

Cognitive Behavioral Therapy (CBT)
CBT teaches you how to change your thought process and beliefs using methodical, repeatable strategies. You can learn to spot when your thoughts around weight and appearance are distorted from reality and attempt to change them. Studies show that the ability to separate the sense of self from an eating disorder17 like anorexia is crucial to recover from it. The effectiveness of CBT is widely noted in the medical community. The Psychiatric Clinics of North America reports, “CBT is the treatment of choice for bulimia nervosa18 and there is evidence that it is as effective with cases of “eating disorder not otherwise specified” (eating disorder NOS), the most common eating disorder diagnosis.”

Dialectical Behavioral Therapy (DBT)
DBT is designed to help you develop practical skills that lead to healthier eating choices. This approach focuses on behavior changes and taking action to bolster your mental health. The skills you learn in DBT include emotional regulation, mindfulness, how to build stronger interpersonal relationships, and distress tolerance. You’re taught to accept your emotions mindfully, and that you are not your emotions. Volatile emotions can exacerbate eating disorder issues, and this type of therapy can help people learn how to regulate them.

Family-Based Therapy (FBT)
Eating disorders can impact the entire family system. FBT opens the door to more effective communication between patients and their family members. It teaches family members that while they may not be responsible for someone’s eating disorder, they can be an important figure in the therapeutic process. It also allows patients to recover with a support system, which can lead to more effective outcomes from therapy. A study conducted by the Stanford University School of Medicine, Lucile Packard Children’s Hospital, and the University of Chicago found that family-based therapy for anorexia is more effective than individual therapy.19

Recovery from Eating Disorders

Struggling, or watching a loved one struggle, with an eating disorder can be anguishing. But it’s important to keep in mind that eating disorders are treatable. With a treatment program fitted to your needs, it’s possible to see significant improvements, and the numbers are promising. A study published in the International Journal of Eating Disorders found that 3 in 4 patients with anorexia nervosa will see levels of improvement following treatment20.

If you’ve determined the need to seek eating disorder treatment, the positive news is there’s a wide variety of plans and programs to choose from. View our directory of rehabs for eating disorders to compare different treatment providers with information like program overviews, pricing, reviews and more.

Reviewed by Rajnandini Rathod

Holistic Treatment for Substance Use Disorders

Holistic treatment, sometimes called alternative treatment, uses a variety of techniques to approach healing. This philosophy considers each client as a whole person, with a deep intrinsic connection between their mind, body, and spirit. More and more rehab programs are implementing holistic therapy to treat substance use disorders.

For the most part, these techniques are not based in Western medicine. The term “holistic therapy” usually refers to Eastern modalities, such as Reiki, yoga, and similar practices. However, there are some exceptions, like certain types of massage therapy. And it can be most effective to combine holistic work with more clinical techniques.

A growing body of research supports the idea that holistic medicine can have a powerful impact on healing. According to the American Medical Association (AMA), “recent changes in medical education have begun to address the need for holistic medical care.” ((Mantri, S. (2008). Holistic medicine and the western medical tradition. AMA Journal of Ethics, 10(3), 177–180. https://doi.org/10.1001/virtualmentor.2008.10.3.mhst1-0803)) These practices can be extremely helpful for clients who are healing from conditions that affect both physical and mental health, such as substance use disorders.

Defining Holistic Treatment

Holistic treatment isn’t just one type of therapy. Instead, this term refers to an overarching philosophy of care. Depending on your specific rehab program, you may participate in any number of different therapeutic techniques.

This perspective is multifaceted, and aims to address many aspects of health at the same time. Specifically, “it addresses the psychological, familial, societal, ethical and spiritual as well as biological dimensions of health and illness. The holistic approach ((Gordon, J. S. (1982). Holistic medicine: Advances and shortcomings. Western Journal of Medicine, 136(6), 546–551. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273970/)) emphasizes the uniqueness of each patient, the mutuality of the doctor-patient relationship, each person’s responsibility for his or her own health care and society’s responsibility for the promotion of health.”

One key difference between most holistic programs and most Western programs is the emphasis on spirituality. For example, some alternative therapies include energy work, such as reiki, or transcendental meditation. However, the gap between Eastern and Western philosophies is beginning to close. Some clinical therapies even have strong foundations in spiritual practices. Dialectical Behavior Therapy (DBT), for example, was inspired by Zen Buddhism.

Data suggests that certain meditative and spiritual practices may have a measurable impact on mental health. The concept of the mind-body connection, in particular, may be extremely important for healing from substance misuse. Experts are calling for more research in this area, and claiming that “brain–body information streams would seem to be necessary elements of a comprehensive model of addiction.” ((Eddie, D., Bates, M. E., & Buckman, J. F. (2022). Closing the brain–heart loop: Towards more holistic models of addiction and addiction recovery. Addiction Biology, 27(1), e12958. https://doi.org/10.1111/adb.12958))

Holistic Therapy for Substance Use

While holistic therapy can refer to a variety of modalities, certain treatments are commonly used in rehab programs. Many of these practices are ancient, with centuries of anecdotal evidence. Nevertheless, more data is needed, as this is a relatively new subject of scientific inquiry. As research continues, many of them are being tailored to meet the unique needs of clients with substance use disorders.

Yoga

Yoga is both a physical and spiritual practice, in which clients move, stretch, breathe, and meditate. It has many well-documented benefits for physical health and can be helpful for those with or without any diagnosis. Specifically, it’s known to relieve muscle pain, reduce symptoms of depression and anxiety, improve sleep and balance, and help with weight loss.

Evidence also suggests that yoga can help manage the symptoms of substance use disorders. ((Kuppili, P. P., Parmar, A., Gupta, A., & Balhara, Y. P. S. (2018). Role of yoga in management of substance-use disorders: A narrative review. Journal of Neurosciences in Rural Practice, 9(1), 117–122. https://doi.org/10.4103/jnrp.jnrp_243_17)) Specifically, research has found that it helps with nicotine withdrawal. It has also been “found to be a feasible and well accepted adjunct treatment for alcohol dependence.” ((Hallgren, M., Romberg, K., Bakshi, A.-S., & Andréasson, S. (2014). Yoga as an adjunct treatment for alcohol dependence: A pilot study. Complementary Therapies in Medicine, 22(3), 441–445. https://doi.org/10.1016/j.ctim.2014.03.003))

Meditation

Meditation is an umbrella term that can refer to a number of practices, but most often includes being still and focusing on one’s own internal experience. Practitioners may sit in silence, clear their minds, listen to guided narratives, perform visualizations, or simply count backward from a high number. Body scans are another popular meditative practice. During this meditation, you gently bring your attention to each area of your body in turn, usually starting with either the head or the feet, and simply notice how it feels in the moment. Mindful breathing is often a big part of meditation. According to Dr. Hari Sharma of the Center for Integrative Medicine at Ohio State University, “An ever-increasing body of research shows various health benefits associated with meditation.”

Specifically, meditation may ease the symptoms of depression and anxiety, improve sleep habits, and even reduce blood pressure. There’s also evidence that it might reduce blood pressure and alleviate gastric symptoms, helping clients with irritable bowel syndrome or ulcerative colitis.

Meditation can also help clients with substance use disorders to “gain self-efficacy skills.” This refers to a person’s belief in their own ability to achieve goals. “Self-efficacy reflects confidence in the ability to exert control over one’s own motivation, behavior, and social environment.” And as you heal from substance misuse, this growing sense of confidence can be extremely important.
Mindfulness
During recovery, mindfulness can help you resist triggers. This collection of strategies teaches clients to stay present in the moment, accepting difficult feelings without acting impulsively. Research has shown these techniques to be “successful for reducing dependence, craving, and other addiction-related symptoms ((Sancho, M., De Gracia, M., Rodríguez, R. C., Mallorquí-Bagué, N., Sánchez-González, J., Trujols, J., Sánchez, I., Jiménez-Murcia, S., & Menchón, J. M. (2018). Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. Frontiers in Psychiatry, 9, 95. https://doi.org/10.3389/fpsyt.2018.00095)) by also improving mood state and emotion dysregulation.”

Mindfulness can also help with overall brain function, ((Alizadehgoradel, J., Imani, S., Nejati, V., & Fathabadi, J. (2019). Mindfulness-based substance abuse treatment (Mbsat) improves executive functions in adolescents with substance use disorders. Neurology, Psychiatry and Brain Research, 34, 13–21. https://doi.org/10.1016/j.npbr.2019.08.002)) which may help clients build healthier, more sustainable habits over time. Specifically, these interventions improve executive function. These skills “are the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully.” Executive function ((Executive function & self-regulation. (n.d.). Center on the Developing Child at Harvard University. Retrieved February 24, 2022, from https://developingchild.harvard.edu/science/key-concepts/executive-function/)) is especially important for those who want to improve memory, self-control, and mental flexibility. It can also help you stay present in your body during difficult moments.

Massage

There are countless types of massage therapy, including Swedish massage, deep tissue, Thai massage, and Shiatsu. While one or more of these modalities may be best for your physical needs, all of them have similar neurological benefits.

Massage therapy increases dopamine and serotonin, the neurotransmitters that help you experience happiness and a sense of achievement. It also decreases cortisol, sometimes called “the stress hormone.” Because of these effects, it is particularly helpful to clients in recovery. Massage can be especially helpful in the early stages of withdrawal, ((Massage and addiction | massage therapy journal. (n.d.). American Massage Therapy Association. Retrieved February 24, 2022, from https://www.amtamassage.org/publications/massage-therapy-journal/massage-and-addiction/)) when patients exhibit low levels of dopamine.

This modality can also alleviate physical pain, and can even improve body awareness. This may help clients practice mindfulness, reconnecting with their own bodies even while they experience uncomfortable symptoms. By focusing on acceptance, it may be easier to navigate certain triggers.

Massage can continue to be helpful throughout the recovery process, ((Adcock, C. L. (1988). Massage therapy in alcohol/drug treatment. Alcoholism Treatment Quarterly, 4(3), 87–102. https://doi.org/10.1300/J020V04N03_07)) even after withdrawal symptoms end. Its benefits include “quicker detoxification, deeper relaxation, and greater self-acceptance.”

Acupuncture

Acupuncture is an ancient form of medicine, in which an acupuncturist inserts needles into specific areas on the client’s body, with the intention of channeling and rebalancing their energy. Some experts believe acupuncture may help clients detox from substance misuse. ((Shwartz, M., Saitz, R., Mulvey, K., & Brannigan, P. (1999). The value of acupuncture detoxification programs in a substance abuse treatment system. Journal of Substance Abuse Treatment, 17(4), 305–312. https://doi.org/10.1016/S0740-5472(99)00010-0))

Preliminary data suggests that this type of therapy is especially helpful for those in recovery from opiate misuse. ((Lin, J.-G., Chan, Y.-Y., & Chen, Y.-H. (2012). Acupuncture for the treatment of opiate addiction. Evidence-Based Complementary and Alternative Medicine : ECAM, 2012, 739045. https://doi.org/10.1155/2012/739045)) However, questions have been raised about the methodology of these studies. While more research is needed, many clients find this modality to be helpful.

The Pros and Cons of Holistic Healing

Holistic medicine may help you reintegrate your sense of self. Because substance misuse impacts both the body and mind, these modalities may remind clients what it means to feel whole. By simultaneously improving your physical and mental health, you can also hone the skills that will help you live a healthier life, even after inpatient treatment.

As one expert describes it, holistic wellness ((Torres-González, F., Ibanez-Casas, I., Saldivia, S., Ballester, D., Grandón-Fernández, P., Moreno-Küstner, B., Xavier, M., & Gómez-Beneyto, M. (2014). Unmet needs in the management of schizophrenia. Neuropsychiatric Disease and Treatment, 97. https://doi.org/10.2147/NDT.S41063)) “is a conscious, deliberate process whereby a person makes choices for a self-defined lifestyle that is both healthier and more satisfying.” This puts you back in control of your own life. Remember that you have both the right and the ability to make healthy choices. If you engage in holistic therapy during rehab, you may be better equipped to live sustainably in the long term.

Some of these treatments, like massage therapy, can also feel like a profound relief. After the stress and trauma of life immediately before rehab, there’s a great benefit to simply experiencing physical comfort. And this type of healthy, sustainable pleasure is also an important part of recovery.

However, it’s important to note that these holistic methods aren’t appropriate for everyone. Many clients need medical treatment in addition to—or instead of—these therapies. This is especially true for clients with certain physical conditions, including chemical dependence on illicit substances.

If you do want to pursue holistic healing, make sure to speak with a medical professional about any potential risks, given your unique health history. For example, a person who has experienced trauma within a religious community might not be a candidate for spiritual practices, like certain kinds of yoga or meditation. You may still be able to benefit from other holistic modalities, but it’s important to proceed carefully and with intention.

Learning to Be Whole

The road to recovery looks different for each person. Even if holistic healing is a good fit, you may find that certain modalities work better for you than others. Remember that the goal of this therapy is to treat each client as a whole and complete person, worthy of great respect, with unique needs and goals.

With that in mind, your needs might or might not be met by these methods. But by listening to yourself, and staying as mindful as you safely can, you’ll be able to choose the best possible path forward.

If you’d like to learn more about holistic therapy for substance use disorders, you can browse our list of holistic rehabs here.

The Basics of Understanding Addiction

No one chooses to be addicted to drugs, alcohol, or gambling. So, what happens? Where does drinking cross the line into an alcohol problem? When does drug use grow from something that makes you feel good to something that takes over your life because if you don’t have it you feel miserable?

What Is Addiction?

Addiction is complex. It is widely accepted that addiction is a disease, involving compulsive use regardless of negative consequences.

The “short” definition of addiction by The American Society of Addiction Medicine (ASAM):

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by an inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

The American Society of Addiction Medicine (ASAM)

Although we’re still exploring the many biological, psychological, and social factors behind how addiction happens, we know for certain drugs, alcohol, and other behaviors, like gambling, gaming, and pornography (typically called “process addictions”), can cause problems in a person’s life and in the lives of those close to that person—and we know addiction is treatable.

Symptoms of Addiction

The drug of choice or behavior of choice will have varying symptoms, but most addictions have the following symptoms. Typically, the more of these symptoms, the more severe the addiction is.

  • Withdrawal symptoms upon stopping
  • Tolerance (you need more of the drug or behavior to get the same effect)
  • Time and energy focused on the behavior and getting next “fix,” especially at the expense of activities once enjoyed
  • Craving
  • Problems related to use:
    • Neglected responsibilities at school, work or home
    • Relationship conflict
    • Physical health problems
    • Mental health issues
  • Lack of control and inability to stop (repeated attempts to quit)

How Common Is Addiction?

Often termed “substance use disorder” (SUD) or “alcohol use disorder” (AUD), addiction affects a number of people worldwide. The United Nations Office of Drugs and Crime (UNODC) World Drug Report 2019, estimates that in 2017, about 35 million people were suffering from a drug use disorder.

More than 35 million people worldwide are suffering from a drug use disorder.

Is Addiction a Disease?

While the disease aspect is still controversial in some circles, in the medical and scientific communities, addiction is considered a disease, a chronic brain disorder.

How Is Addiction Treated?

A spectrum of treatment options exist to help people struggling with drugs and alcohol or process addictions.

Typically addiction is treated through a combination of psychotherapies, support groups, and sometimes medicine. Some people have found recovery simply by attending support groups regularly. Others have found individual counseling coupled with support group attendance

How Do I Know If I Have a Drug Problem

A person may know they have a drug problem if they have become dependent on a drug and feel like the drug is needed for functioning. Another way an individual can tell if their drug use is causing a problem is if they are experiencing negative consequences in their home, work, or personal relationships.

When Does Using Drugs Become a Problem?

Drug usage in someone’s life becomes a problem when it negatively affects an individual’s mental, emotional, and physical health. This may manifest as an addiction, withdrawal symptoms, illegal activity, or other negative consequences in their life or the lives of family and friends.

Drugs can also become a problem in someone’s life when they depend on the drug for achieving personal fulfillment at the expense of themselves and/or others.

DSM-V and ICD-10 Criteria for Substance Use Disorders

The table below features the DSM-V and ICD-10 which can be used as a guide to determine if drug usage may be a problem in your life or your loved ones life.

This table is not to be used for a self-diagnosis. Please seek help from a mental health professional for a real diagnosis if you feel like you or your loved one may be experiencing a drug problem.

DSM-V ICD-10
The presence of at least 2 of the symptoms in the chart below indicates an individual may have a Substance Use Disorder. The severity is defined as: Mild: 2-3 symptoms, Moderate 4-5 symptoms, and Severe 6+ symptoms. The presence of 3 or more of the following should be present together for at least 1 month, or repeatedly during a 1 year period.
In the past year, have you? Have you had?
Had times when you ended up taking the substance more, or longer, than you intended? A strong desire or sense of compulsion to take the psychoactive substance?
More than once wanted to cut down or stop taking the substance, or tried to, but couldn’t? Difficulties in controlling substance-taking behavior in terms of its onset, termination, or levels of use?
Spent a lot of time taking the substance? Or being sick or getting over other aftereffects? A physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms?
Wanted the substance so badly you couldn’t think of anything else? Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses?
Found that taking the substance interfered with taking care of your home or family? Or caused job troubles? Or school problems? Progressive neglect of alternative pleasures or interests because of psychoactive substance use?
Continued to take the substance even though it was causing trouble with your family or friends?
Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to take the substance?
More than once gotten into situations while or after taking the substance that increase your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area?)
Continued to take the substance even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
Had to take more of the substance much more than you once did to get the effect you want? Or found that your usual drug dose had much less effect than before?
Found that when the effects of drugs were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating or racing heart?

DSM-V contains a list of criteria that helps determine if an individual may have a Substance Use Disorder. The DSM-V is the Diagnostic and Statistical Manual of Mental Disorders developed by the American Psychiatric Association in 1952. As research and data continues, the APA updates the DSM with current information which is why there is the letter V for the 5th edition.

ICD-10 contains a  list of criteria that helps determine if an individual may have a Substance Use Disorder. The ICD-10 is the International Classification of Diseases developed by the United States National Center for Health Statistics (NCHS) in 1893. As research and data continues, the APA reviews and updates the ICD with current information which is why there is the number 10 for the 10th revision.

How Can You Find Out?

Many will say if you’re questioning, then that means you have a drug problem and should seek help. Here are a few other ways you can find out if you have a drug problem.

Talk to Your Primary Care Physician

Talk to your primary care physician about your drug use and be honest. They can conduct an assessment and refer you to another health professional or level of care if needed.

Get an Assessment with a Mental Health Professional

The best and recommended way to know if you have a drug problem is to get an assessment with a mental health professional. Since they’re experts, they’ll be able to assess the severity of a substance use disorder and recommend the level of treatment you need. You can talk to your GP about a mental health assessment or find other providers who can give one.

Try Minimizing or Stopping Drugs

Note: this is not safe if you consistently take drugs, as drug withdrawal can be life-threatening. If you have not become dependent on drugs though and think you may have a problem, see if you can go without the drug or significantly reduce your drug intake. Does it cause anxiety? Are you struggling to stop?

Take an Online Quiz

Here are a few common online quizzes regarding drugs. The general quizzes below are not meant to be a diagnosis, but more of a spectrum guide of your drug usage.