Physical treatment for addiction

Treatment aims to protect an addict's mental and physical health, and to minimise the effects on their family and society as a whole.

Controlled consumption

Clearly, if excessive consumption is doing harm, then consuming less will, by and large, be less harmful. However, one of the problems for nearly all addicts is that they lose the ability to control their consumption, and regaining control is rarely achieved for any length of time. In a few cases this can work, but in most attempting to control consumption is at best only a useful demonstration to the denying individual that they’re, indeed, addicted.

Abstinence

Once confronted, addicts will rarely consider abstinence at first, and it may take repeated efforts at controlled consumption together with a general deterioration of health to compel them to realise that their only prospect of recovery is total abstinence.

The transition from dependency to abstinence is almost invariably traumatic, frightening, painful and sometimes dangerous. Some achieve this on their own, others with the support of friends, and others may need a period of medical supervision that includes supportive medication, a process known as 'detoxification'.

However, giving up taking the substance is not the end of addiction and relapse is common. That is why the best chance of maintaining abstinence is when withdrawal is accompanied by treatments such as counselling, behavioural therapies or other psychological support which help the individual rethink their habit.

Substitute medication

In some cases it may be helpful to replace the addictive substance with something which still gives some of the desired effect but which is less risky to health. This is known as substitute medication.

For example, most of the physical harm from heroin comes from the accidental injection of viruses and harmful bacteria through sharing and reusing injecting equipment. Drug agencies or clinics can supply addicts with sterile disposable syringes and needles to reduce the risk of infection, but better still is to get heroin addicts to stop injecting altogether.

Synthetic opiates such as methadone can be prescribed to addicts to use instead of heroin, and a daily dose (usually as a liquid or tablet taken by mouth) will prevent craving and withdrawal. As well as avoiding the need for injection, a prescription like this can help stop an addict from having to resort to crime or prostitution in order to get their fix, so reducing harm to themselves and the community. However, these drugs are also addictive, sometimes more so than heroin. And because they give little 'reward', addicts often continue to use heroin as well as their substitute prescription.

Nonetheless, methadone prescribing has been shown to lower deaths and infection rates among heroin addicts, as well as reducing criminality.

Another common example of substitute medication is nicotine replacement treatments such as gum or patches. These provide a source of nicotine that the smoker craves without exposing them to all the other harmful chemicals in tobacco smoke.

Other medications

Several other groups of drugs have limited use in addiction; some reduce craving, some block the effects of the addictive drug (Naltrexone, for example, blocks the effects of heroin) and some create unpleasant symptoms if the patient consumes his drug of choice. All of these have their place, but are of little use if relied upon with no other support mechanisms.

Medically supervised withdrawal

Patients who are heavy, consistent users and who are likely to experience withdrawal complications require medically supervised withdrawal (detoxification). A withdrawal syndrome that can develop on stopping use of a drug will vary according to the type of drug the person was using. Common features include craving for the substance, anxiety, restlessness, irritability, insomnia and impaired attention.

Support during withdrawal is especially important in addiction with the following types of drugs - opiates, barbiturates, benzodiazepines and alcohol - where cessation of use may be followed by a classic physiological withdrawal syndrome.

Medically supervised withdrawal can be provided in a community or a residential (inpatient) setting (sometimes known as a Drug Rehabilitation or 'Rehab' clinic), according to the needs of the patient and availability of services. Talk to your GP or local drug clinic about what is available in your area.