Editing Substance abuse (section)

==Treatment==
{{main|Drug rehabilitation}}

===Psychological===
From the [[applied behavior analysis]] literature, [[behavioral psychology]], and from randomized [[clinical trials]], several evidenced based interventions have emerged: [[Integrative behavioral couples therapy|behavioral marital therapy]], [[motivational Interviewing]], [[Community Reinforcement Approach|community reinforcement approach]], [[exposure therapy]], [[contingency management]]<ref>{{Cite journal| last = O'Donohue| first = W|author2=K.E. Ferguson | title = Evidence-Based Practice in Psychology and Behavior Analysis| journal = The Behavior Analyst Today| volume = 7| issue = 3| pages = 335–350| year = 2006| url = http://www.baojournal.com|access-date=2008-03-24| doi=10.1037/h0100155}}</ref><ref>{{Cite journal| last = Chambless|first = D.L.| title = An update on empirically validated therapies| journal = Clinical Psychology| volume = 49| pages = 5–14| year = 1998| url = http://www.apa.org/divisions/div12/est/newrpt.pdf| access-date = 2008-03-24|display-authors=etal}}</ref> They help suppress cravings and mental anxiety, improve focus on treatment and new learning behavioral skills, ease withdrawal symptoms and reduce the chances of relapse.<ref>{{cite web|url=http://nihseniorhealth.gov/drugabuse/treatingsubstanceabuse/01.html|title=NIH Senior Health "Build With You in Mind": Survey|publisher=nihseniorhealth.gov|access-date=29 July 2015|archive-url=https://web.archive.org/web/20150811235108/http://nihseniorhealth.gov/drugabuse/treatingsubstanceabuse/01.html|archive-date=2015-08-11|url-status=dead}}</ref>

In children and adolescents, [[cognitive behavioral therapy]] (CBT)<ref>{{Cite web| url=http://www.abct.org/sccap/?m=sPublic&fa=pub_WhatIsCBT| archive-url=https://web.archive.org/web/20100421114203/http://www.abct.org/sccap/?m=sPublic&fa=pub_WhatIsCBT| url-status=dead| archive-date=2010-04-21| title=Association for Behavioral and Cognitive Therapies – What is CBT?}}</ref> and [[family therapy]]<ref>{{Cite web|url=http://www.abct.org/sccap/?m=sPublic&fa=pub_WhatIsFT |archive-url=https://web.archive.org/web/20100613124757/http://abct.org/SCCAP/?m=sPublic&fa=pub_WhatIsFT |url-status=dead |archive-date=2010-06-13 | title =Association for Behavioral and Cognitive Therapies – What is Family Therapy?}}</ref> currently has the most research evidence for the treatment of substance abuse problems. Well-established studies also include ecological family-based treatment and group CBT.<ref name=Hogue>{{cite journal|last1=Hogue|first1=A|last2=Henderson|first2=CE|last3=Ozechowski|first3=TJ|last4=Robbins|first4=MS|title=Evidence base on outpatient behavioral treatments for adolescent substance use: updates and recommendations 2007–2013.|journal=Journal of Clinical Child and Adolescent Psychology |date=2014|volume=43|issue=5|pages=695–720|pmid=24926870|doi=10.1080/15374416.2014.915550|s2cid=10036629}}</ref> These treatments can be administered in a variety of different formats, each of which has varying levels of research support<ref>{{Cite web | url=http://www.abct.org/sccap/?m=sPublic&fa=pub_AlcoholAbuse | archive-url=https://web.archive.org/web/20100421114343/http://www.abct.org/sccap/?m=sPublic&fa=pub_AlcoholAbuse | url-status=dead | archive-date=2010-04-21 | title=Association for Behavioral and Cognitive Therapies – Treatment for Substance Use Disorders }}</ref> Research has shown that what makes group CBT most effective is that it promotes the development of social skills, developmentally appropriate emotional regulatory skills and other interpersonal skills.<ref>{{Cite journal|last1=Engle|first1=Bretton|last2=Macgowan|first2=Mark J.|date=2009-08-05|title=A Critical Review of Adolescent Substance Abuse Group Treatments|journal=Journal of Evidence-Based Social Work|volume=6|issue=3|pages=217–243|doi=10.1080/15433710802686971|issn=1543-3714|pmid=20183675|s2cid=3293758}}</ref> A few integrated<ref name="crd.york.ac.uk">{{Cite web|url=http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12011000198|title=Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: a meta-analysis|website=crd.york.ac.uk|access-date=2016-03-09}}</ref> treatment models, which combines parts from various types of treatment, have also been seen as both well-established or probably effective.<ref name=Hogue /> A study on maternal alcohol and other drug use has shown that integrated treatment programs have produced significant results, resulting in higher negative results on toxicology screens.<ref name="crd.york.ac.uk"/> Additionally, brief school-based interventions have been found to be effective in reducing adolescent alcohol and cannabis use and abuse.<ref>{{Cite journal|title=Brief school-based interventions and behavioural outcomes for substance-using adolescents|journal = Cochrane Database of Systematic Reviews|issue = 1|pages = CD008969|last1=Carney|first1=Tara|last2=Myers|first2=Bronwyn J|last3=Louw|first3=Johann|last4=Okwundu|first4=Charles I|date=2016-01-20| volume=2016 |doi=10.1002/14651858.cd008969.pub3|pmid = 26787125|pmc = 7119449|hdl = 10019.1/104381|hdl-access=free}}</ref> [[Motivational interviewing]] can also be effective in treating substance use disorder in adolescents.<ref>{{Cite journal|last1=Jensen|first1=Chad D.|last2=Cushing|first2=Christopher C.|last3=Aylward|first3=Brandon S.|last4=Craig|first4=James T.|last5=Sorell|first5=Danielle M.|last6=Steele|first6=Ric G.|title=Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: A meta-analytic review.|journal=Journal of Consulting and Clinical Psychology|volume=79|issue=4|pages=433–440|doi=10.1037/a0023992|pmid=21728400|year=2011|s2cid=19892519}}</ref><ref>{{Cite journal|last1=Barnett|first1=Elizabeth|last2=Sussman|first2=Steve|last3=Smith|first3=Caitlin|last4=Rohrbach|first4=Louise A.|last5=Spruijt-Metz|first5=Donna|title=Motivational Interviewing for adolescent substance use: A review of the literature|journal=Addictive Behaviors|volume=37|issue=12|pages=1325–1334|doi=10.1016/j.addbeh.2012.07.001|pmc=3496394|pmid=22958865|year=2012}}</ref>

[[Alcoholics Anonymous]] and [[Narcotics Anonymous]] are widely known self-help organizations in which members support each other abstain from substances.<ref>{{cite web|url=http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm|title=Self-Help Groups Article|access-date=May 27, 2015|archive-date=May 21, 2015|archive-url=https://web.archive.org/web/20150521163926/http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm|url-status=dead}}</ref> [[Social skills]] are significantly impaired in people with [[alcoholism]] due to the [[neurotoxic]] effects of alcohol on the brain, especially the [[prefrontal cortex]] area of the brain.<ref name="pmid18412750">{{cite journal |vauthors=Uekermann J, Daum I |title=Social cognition in alcoholism: a link to prefrontal cortex dysfunction? |journal=Addiction |volume=103 |issue=5 |pages=726–35 |date=May 2008|pmid=18412750|doi=10.1111/j.1360-0443.2008.02157.x }}</ref> It has been suggested that [[social skills]] training adjunctive to inpatient treatment of alcohol dependence is probably efficacious,<ref>{{cite journal |author1=Purvis G. |author2=MacInnis D. M. | year = 2009 | title = Implementation of the Community Reinforcement Approach (CRA) in a Long-Standing Addictions Outpatient Clinic | url = http://baojournal.com/Health%20Journal/JBAHSFM-2-1.pdf | archive-url = https://web.archive.org/web/20101229132307/http://www.baojournal.com/Health%20Journal/JBAHSFM-2-1.pdf | url-status = dead | archive-date = 2010-12-29 | journal = Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine | volume = 2 | pages = 133–44 }}</ref> including managing the social environment.

===Medication===
{{See also|Drug rehabilitation#Medications}}
A number of medications have been approved for the treatment of substance abuse.<ref>{{cite web|publisher=The California Evidence-Based Clearinghouse|title=Current Pharmacological Treatment Available for Alchhol Abuse|date=2006–2013|url=http://www.cebc4cw.org/search/by-topic-area/pharmacological-treatment-for-substance-abuse/alcohol-abuse/}}</ref> These include replacement therapies such as [[buprenorphine]] and [[methadone]] as well as antagonist medications like [[disulfiram]] and [[naltrexone]] in either short acting, or the newer long acting form. Several other medications, often ones originally used in other contexts, have also been shown to be effective including [[bupropion]] and [[modafinil]]. Methadone and [[buprenorphine]] are sometimes used to treat opiate addiction.<ref>{{Cite book |last=Kalat |first=James W. |url=https://www.worldcat.org/oclc/772237089 |title=Biological Psychology |date=2013 |publisher=[[Cengage|Wadsworth, Cengage Learning]] |isbn=978-1-111-83100-4 |edition=11th |location=Belmont, CA |pages=81 |oclc=772237089}}</ref> These drugs are used as substitutes for other opioids and still cause withdrawal symptoms but they facilitate the tapering off process in a controlled fashion. When a person goes from using fentanyl every day, to not using it at all, they will experience a point where they need to get used to not using the substance. This is called withdrawal.{{citation needed|date=September 2023}}

Antipsychotic medications have not been found to be useful.<ref>{{cite journal|last=Maglione|first=M |author2=Maher, AR |author3=Hu, J |author4=Wang, Z |author5=Shanman, R |author6=Shekelle, PG |author7=Roth, B |author8=Hilton, L |author9=Suttorp, MJ |author10=Ewing, BA |author11=Motala, A |author12=Perry, T|title=Off-Label Use of Atypical Antipsychotics: An Update [Internet]. |journal= Agency for Healthcare Research and Quality  |id= Report No.: 11-EHC087-EF |date=September 2011|pmid=22132426}}</ref> Acamprostate<ref>{{Cite journal|vauthors=Lingford-Hughes AR, Welch S, Peters L, Nutt DJ, ((British Association for Psychopharmacology, Expert Reviewers Group))|date=2012-07-01|title=BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP|journal=Journal of Psychopharmacology|volume=26|issue=7|pages=899–952|doi=10.1177/0269881112444324|issn=0269-8811|pmid=22628390|doi-access=free}}</ref> is a glutamatergic NMDA antagonist, which helps with alcohol withdrawal symptoms because alcohol withdrawal is associated with a hyperglutamatergic system.

===Heroin-assisted treatment===
[[File:Opiates v opioids.png|thumb|right|600px|Opiates v opioids illustrated with diagrams and sub-classifications]]
Three countries in Europe have active [[Heroin-assisted treatment|HAT programs]], namely [[England]], the [[Netherlands]] and [[Switzerland]]. Despite critical voices by conservative think-tanks with regard to these harm-reduction strategies, significant progress in the reduction of drug-related deaths has been achieved in those countries. For example, the US, devoid of such measures, has seen large increases in drug-related deaths since 2000 (mostly related to heroin use), while Switzerland has seen large decreases. In 2018, approximately 60,000 people have died of drug overdoses in America, while in the same time period, Switzerland's drug deaths were at 260. Relative to the population of these countries, the US has 10 times more drug-related deaths compared to the Swiss Confederation, which in effect illustrates the efficacy of HAT to reduce fatal outcomes in opiate/opioid addiction.<ref>{{Cite web |title=Drogentote |url=https://www.obsan.admin.ch/de/indikatoren/MonAM/drogentote |archive-url=https://web.archive.org/web/20220915210129/https://ind.obsan.admin.ch/indicator/monam/drogentote |archive-date=15 September 2022 |access-date=23 December 2020 |website=Swiss Health Observatory (OBSAN)}}</ref><ref name="NIDA-deaths">{{Cite web |title=Overdose Death Rates |url=https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates |archive-url=https://web.archive.org/web/20220917133141/https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates |archive-date=17 September 2022 |access-date=23 December 2020 |website=[[National Institute on Drug Abuse]]}}</ref>

===Dual diagnosis===
{{main|Dual diagnosis}}
It is common for individuals with drugs use disorder to have other psychological problems.<ref name=bap>{{cite journal | author1 = Lingford-Hughes A. R. | author2 = Welch S. | author3 = Peters L. | author4 = Nutt D. J. | year = 2012 | title = BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP | journal = Journal of Psychopharmacology | volume = 26 | issue = 7 | pages = 899–952 | doi = 10.1177/0269881112444324 | pmid = 22628390 | s2cid = 30030790 | doi-access = free }}</ref> The terms "dual diagnosis" or "co-occurring disorders", refer to having a mental health and substance use disorder at the same time. According to the British Association for Psychopharmacology (BAP), "symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather than the exception in patients misusing drugs and/or alcohol."<ref name = nih>{{cite journal | author = Peterson Ashley L | year = 2013 | title = Integrating Mental Health and Addictions Services to Improve Client Outcomes | journal = Issues in Mental Health Nursing | volume = 34 | issue = 10| pages = 752–756 | pmid = 24066651 | doi=10.3109/01612840.2013.809830| s2cid = 11537206 }}</ref>

Individuals who have a comorbid psychological disorder often have a poor prognosis if either disorder is untreated.<ref name = bap/> Historically most individuals with dual diagnosis either received treatment only for one of their disorders or they did not receive any treatment all. However, since the 1980s, there has been a push towards integrating mental health and addiction treatment. In this method, neither condition is considered primary and both are treated simultaneously by the same provider.<ref name = nih/>