How Has Modern Psychiatry Improved Addiction Treatment?
To appreciate the impact of modern psychiatry on addiction treatment, a distinction needs to be made between substance addiction and dependence to drugs like clonazepam. Psychoactive drugs affect the central nervous system (CNS) and interfere with naturally occurring processes, and the body eventually compensates by becoming physically reliant on the substance being abused. This is known as physical dependence. Addiction, on the other hand, is a neurobiological disease that affects memory, motivation, circuitry and reward structures in the brain. Though physical changes occur, addiction is classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and involves psychological issues like impulsive behavior and obsessive thoughts. For this reason people can develop addictions but not dependence on behaviors like gambling, shopping and hoarding. The emergence of modern psychiatry introduced progressive new modalities and therapies that help with all mental health disorders including addiction. Several therapies in particular have been especially useful.
Cognitive Behavioral Therapy
The National Alliance on Mental Health (NAMH) website says Cognitive Behavioral Therapy (CBT) focuses on negative thought patterns and irrational beliefs that affect emotions and conduct. The American Journal of Psychiatry in 2005 says it helps addicts in several ways including the following:
- Addiction is explained in the context of real-life antecedents and consequences.
- Patients learn to recognize situations and states that can trigger cravings or relapse.
- Strategies are developed to avoid or cope with high-risk substance use situations.
Though first developed a few decades before, CBT went main stream in the 1980s as an effective mood treatment, and the National Institute on Drug Abuse (NIDA) helped promote efficacy studies involving addiction in the 1990s. First applied to alcohol addiction and then cocaine, CBT produced positive recovery results, and it soon became a staple therapy is many rehabilitation programs.
Dialectical Behavioral Therapy
Promoted in the 1990s as an alternative to CBT, Dialectical Behavioral Therapy (DBT) is often more effective with patients who have certain issues including the following:
- Strong sensitivity to criticism
- Borderline personality disorder
- Histories of suicide attempts and self-harm
DBT creates a co-existing environment for acceptance and change. Sessions begin by validating the patients and helping them accept who they are in a positive way. Change is then presented as a mutually productive extension of acceptance, and therapists help promote change with life skills training and emotional growth. More recently DBT for Substance Abusers emerged, and the Addiction Science & Clinical Practice journal in 2008 highlighted some of its therapeutic goals, which include the following:
- Therapists request realistic short-term abstinence periods.
- Patients are regularly asked to renew or extend these periods.
- Abstinence commitments are balanced with relapse recovery strategies.
- Therapists actively seek out patients who drop out or skip sessions.
The modality also uses Eastern philosophies and principles that promote balance and harmony.
The Substance Abuse and Mental Health Services Administration (SAMHSA) describes motivational interviewing (MI) as a collaborative process in which the therapist and patients work together to foster personal desires to change. MI involves several key principles including the following:
- Determine the patients’ personal life goals.
- Show discrepancies between their behavior and goals.
- Project acceptance instead of disapproving censure.
- Engage the patients and avoid confrontations.
MI is often used with patients who display apathy. This may include people who begrudgingly entered treatment because of an intervention, alternative sentencing or other non-personal motivation.
According to the Alcohol Research & Health journal in 1999, the community-reinforcement approach (CRA) seeks to eliminate positive reinforcement for substance abuse and create positive reinforcement for abstinence and recovery. Elements of CRA include the following:
- Help the patient initiate sobriety and recovery.
- Find and develop motivations to stay clean.
- Analyze substance use patterns and triggers.
- Teach new coping strategies and behaviors.
- Get friends and loved ones involved in the process.
Involving friends and family in recovery is a long-time practice, but CRA teaches principles and tools that the community can use to be more effective.
In 1999 the Alcohol Research & Health journal also highlighted contingency management (CM). Utilizing the simple yet effective idea of reward, CM encourages positive change and recovery by creating treatment goals and giving rewards for meeting them. This typically involves written contracts that detail specific terms including the following:
- The desired change and goal
- How compliance will be monitored
- Duration of the commitment
- Consequences for success or failure
A possible reward, for example, might be a voucher or gift certificate for retail goods. Of course an effective contract includes various commitments, such as attending group meetings and counseling sessions, which help produce the positive outcomes.
Co-Occurring Mental Health Disorders
As with the therapies listed above, most modern psychiatric modalities were developed for mental health disorders and later applied to substance abuse. Some researchers suggest that mental health issues and addiction are simply different manifestations of similar genetic abnormalities, and they are often present together as co-occurring disorders. This is a significant reason why modern psychiatry has been helpful to addiction treatment, and rehabilitation centers often use integrated therapies to address addiction and mental health disorders together.
Likewise a mental health disorder may have motivated the original substance use. For example a person with anxiety or panic attacks may take Klonopin (clonazepam) to reduce the symptoms, but benzodiazepine-class drugs like clonazepam can produce an addiction with extended use. Psychiatric therapies that treat both addiction and anxiety help minimize a potentially significant relapse trigger.
Free Addiction Hotline
Revolutionary advancements in modern psychiatry have made addiction treatment more effective than ever before. If you or a loved one struggles with addiction, call our toll-free helpline for more information. Our admissions coordinators can take your call 24 hours a day to answer questions, explain treatment options, recommend facilities and even check health insurance policies for rehabilitation benefits. Untreated addiction only gets worse, so if you need help, please call now.