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Problems that Usually Need
Psychotherapy or Psychiatry Treatment
Drugs | Alcohol | Substance Abuse
This section is for people having trouble with substance abuse or dependence, and for friends and family members of substance abusers.
Many people in our society consume intoxicating substances to various degrees and for different reasons. This becomes a problem requiring treatment when it turns into substance abuse or dependence. Substance abuse means consuming so much at one time that one puts oneself or others at risk, and dependence means that the person needs the substance on a continuing basis in order to avoid anxiety, depression, withdrawal, or other negative feelings. Both of those are problems that need to be solved, and both usually require treatment.
When people talk about treatment for sub-stance abuse, they usually think about rehab (short for rehabilitation), which refers to a patient checking into a treatment facility and staying there for several weeks or possibly even months while being treated. This is generally needed in severe cases. People are also aware of regular weekly outpatient psycho- therapy. This is usually insufficient for most substance abuse cases, although it can be helpful to maintain sobriety after a higher level of treatment is completed.
There is another important treatment option many people are unaware of, called an Intensive Outpatient Program, or IOP. IOP programs provide treatment for three or four hours a day, usually three to five days a week. Treatment includes individual, group, and family psychotherapy, educational groups, and psychiatric medication if needed. These programs are operated by hospitals and substance abuse treatment centers, and are covered by insurance. You can access them easily by calling your insurer and asking which substance abuse IOP programs in your area are part of their network. They will give you a list, and then you choose one and call them to schedule an intake appointment. (You do the same thing to find a rehab facility.) Some IOP programs run in the evenings to accommodate people who work during the day, others run during daytime hours.
An important question to ask is whether someone needs rehab or IOP. A very rough rule is that if someone consumes substances daily and throughout the day and has become dysfunctional in most areas of life, then rehab is needed. If someone continues to function in some areas such as work and can refrain from using substances for part of the day, then IOP may be sufficient. It is also much easier to persuade people to enter IOP programs than to go to rehab. If someone enters an IOP program and it is not sufficient, then the IOP will refer the person to an appropriate rehab facility.
Another important form of treatment for substance abuse is 12-step programs. The most well known are Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), and there are also 12-step programs for behavioral addictions, including Gamblers Anonymous (GA) and Overeaters Anonymous (OA).
These programs are organized and conducted by non-clinicians with histories of addiction, they are free, they are open to anyone, and they are incredibly helpful. You can easily find 12-step programs on the Internet by typing the name of the program (like Alcoholics Anonymous) and your city and state into a search engine like Google. You will get a list of meetings that take place weekly, with their time and place, and it will also tell you the type of meeting. There are open meetings that anyone can attend, and you just go there and walk in, there is no need to call ahead and make arrangements. Anyone can speak freely, but no one is required to speak. Many people at first choose to go just to listen. Some meetings allow smoking, some prohibit it, and they usually serve coffee.
If you attend an IOP program or go into a rehab, 12-step meetings are often part of treatment. Rehabs frequently will have their own 12-step meetings inside the facility, and IOP programs will recommend meetings in the community to go to.
When someone has just stopped using drugs or alcohol and has been sober only a short time, daily meetings are often necessary to fight through cravings. Many people with substance abuse problems are resistant to the idea of 12-step programs, for various reasons. Some people feel that it is cult-like or quasi-religious, and they object to that. Some feel too ashamed to talk about their problems. Others are in denial about the severity of their problem. Still others simply don’t really want to stop using. Whatever the reasons for not wanting to attend, people should understand that 12-step programs have a proven track record at helping people with addictions. You don’t have to agree with everything said at a meeting to get help from it.
Thomas B. Hollenbach, Ph.D.
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