What is drug dependency?
“Drug dependence is a chronic relapsing medical condition. Drug dependence is not based on personal weakness or morals.”
Drug dependency is both physical and psychological. With physical dependency the person using a drug over a period of time will have developed an intense reliance on drugs, often to avoid difficult withdrawal symptoms. The person will often crave (have a powerful desire) to use the drugs despite the damaging consequences to their physical, mental and social well-being.
Drug users also experience psychological dependence in which they believe it is necessary to use drugs to function, sometimes just at social gatherings or all the time.
Treatment Options
“No single treatment is appropriate for everyone.”
Evidence shows there is no single drug treatment that works for everyone, and some treatments are more effective than others. Drug treatments primarily focus on changing behaviour and/or prescribing alternative drugs (for withdrawal and drug substitution) or a combination of both.
These drug treatment options are:
1. Counselling
Counselling is the most common kind of treatment and for many people, this can be the first opportunity to openly discuss with others (professionals) about their drug use. Counselling might involve talking through your problems, learning to change the way you think, or thinking about how you might deal with a difficult situation. Counselling can be provided individually or in a group situation, and is available both to people who use drugs, and to their family members or other support people. For many, counselling can be an ongoing process and is mostly combined as a useful component with the other forms of treatment.
2. Detoxification
The treatment of chronic drug use generally requires a person to go through a period of detoxification (process of removing all forms of harmful drugs from the body) or withdrawal in order to achieve complete stoppage of drug use.
The process of detoxification involves getting rid of the drugs from the body which can usually be achieved in 7-14 days. Detoxification works best as the first stage in a comprehensive rehabilitation process and aims to keep the drug user safe wit minimal discomfort. It involves prescribing medications for the various symptoms of withdrawal as well as providing counselling and ongoing support. When detoxification is only focused on the physical and not the social and psychological dimension of drug dependency, the effectiveness of the treatment is weakened.
3. Abstinence-Based Treatment
Drug treatment settings may include residential, outpatient and mutual help and support groups. Treatment settings and what they offer can vary depending on individual needs, often the types of drugs used, and commonly what is available and affordable in the community.
4. Residential Rehabilitation
Residential rehabilitation is based on the principle that a drug free residential setting is helpful for comforting the underlying causes of drug dependency and associated behaviours. In this setting, the focus is on the “un-learning” of negative behaviours and developing the required skills and positive attitude to assist drug users to achieve a drug free lifestyle. Residential treatment programmes offer various psychosocial support and counselling/therapy sessions. Research suggests that in order to achieve behavioural change, at least three months in treatment is necessary.
5. Outpatient
Outpatient programmes range from drop-in centres to individual and group counselling sessions which provide education, medical and psychological services. These programmes have far less restrictions than residential programmes and consequentially are more suited to those living in a stable and supportive environment or for those that do not have the financial resources for residential treatment. As with residential treatment psychosocial support and counselling is provided for some of the following reasons: to support lifestyle adjustments and reduce risk behaviors; address a person’s motivation to change; provide incentives to encourage stopping drug use; establishing skills to resist drug use; exploring ways of replacing drug use activities with more constructive and rewarding activities; improving problem-solving skills and; seeking ways to improve a drug user’s relationship with others, such as family and friends.
6. Mutual Help and Support Groups
Mutual help and support groups are based on the principles of Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). These are primarily run by recovering group members rather than professionals, and they have adopted a philosophy that recovery from drug dependency can occur but there is no cure. The ’12 steps’ approach of AA/NA has a strong spiritual emphasis. Meetings commonly revolve around discussion, testimonials, confessions of past or present drug use problems and working through the 12 steps. Through this process members receive support, fellowship and the desired motivation to maintain their recovery.
7. Drug Substitution Programmes
Drug substitution involves replacing one drug (such as heroin) with another medically prescribed drug. Most substitution programmes targeting illegal drug users are primarily for opioid-dependent persons. Short term treatment often does not prove effective which is why 12 months of treatment is encouraged as the minimum.
Conclusion
“Effective treatment must attend to multiple needs of the individual and not just a person’s drug use.”
Investment in treatment programmes can yield significant returns such as reduced drug related crime and improved health outcomes. It is important to manage expectations as the journey to long-term abstinence is a slow and incremental (step by step) process. Research supports treatment but it is important to have sufficient resources and human skills to contribute towards these interventions. A balanced approach is required and the best treatment programmes offer a combination of therapies and linkages with other services.
(This excerpt was originally published as a response to drugs and related organised crime in Nigeria, developed in collaboration with UNODC and Nigerian stakeholders and funded by the European Union).