Treatment Theories & Applications for Drug Dependency

The fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM IV) classified substance dependence as a disease. Mental health professionals commonly use this reference when diagnosing patients. In April 2010, the American Psychiatic Association issued a draft of the DSM V that eliminates the disease category and places substance abuse and dependence under the category of "addictions and related disorders." There has long been disagreement in the medical and mental health fields about how to classify substance dependence. Little wonder, then, that there are numerous theories about how to treat it, and a wide array of treatment options available.

Definition

• The term "dependence" is often used interchangeably with "addiction," though Dr. Charles O'Brien of the American Psychiatric Association feels that this leads to confusion. The physical tolerance and withdrawal people have to drugs, he says, "are very normal responses to medications that affect the central nervous system," whereas addiction is "compulsive drug-seeking behavior." But researcher Stanton Peele, Ph.D.--responding to the DSM change--says he has always used the term "addiction" in the books he's written. Those who seek treatment for drug dependence have a behavioral problem, because they can't resist the desire to do drugs regardless of the harm they cause. Such people may or may not have a physical dependence.

Models

• There are three basic approaches to substance dependence treatment based on differing theories about how addiction arises in the first place. The disease model proposes that addiction is a disease over which the sufferer has no control. The physical dependence model supposes that addicts continue using drugs because, after repeated use, their bodies develop withdrawal symptoms if they abstain, and they seek to avoid this negative reinforcement. The third model is positive reinforcement and suggests that the intensely pleasurable sensations produced by addictive drugs alter a person's behavior, making the compulsion to continue using the drug more likely.

Professional Treatment

• Various medications help ease physical withdrawal symptoms and decrease craving. Opioids like methadone, for example, are used to wean addicts off opiates. Some medications act as a deterrent, such as disulfiram, which makes alcoholics feel nauseous if they drink alcohol.

  Counseling makes substance-dependent patients aware of the underlying psychological or emotional issues that led to their drug abuse. Cognitive behavioral therapy helps patients recognize and avoid behavior that leads to drug use and replaces those behaviors with positive ones. Motivational therapy uses positive reinforcements, or "rewards," to encourage continued abstinence.

  Therapeutic communities represent another professional approach in which patients are placed in rehabilitation centers with other addicts. These centers help addicts develop social skills and usually offer withdrawal medication for those who need it, as well as different types of counseling.

12-Step Programs

• Beginning with Alcoholics Anonymous in the 1930s, 12-step programs have existed independently of medical and mental health professionals. They are independent, nonprofit organizations of people who have developed a "spiritual" model of recovery from alcohol and drugs. Participation is voluntary and involves people meeting in groups to discuss their problems in relationship to the 12 steps--spiritually based actions that help them overcome the desire to abuse substances and reintegrate into society.

Expert Insight

• Dr. Marc Galanter of New York University wrote in the April 2007 "Journal of Substance Abuse Treatment" that the spiritual model of 12-step programs can serve as an empirical model for mental health professionals as they continue to refine their therapeutic techniques. Defining spirituality as "that which gives people meaning and purpose in life," he suggests that cognitive behavioral therapy, motivational therapy and other professional approaches to substance abuse seek the same end.