Drug addiction (substance use disorder)

Diagnosis

Diagnosing drug addiction (substance use disorder) requires a thorough evaluation and often includes an assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor. Blood, urine or other lab tests are used to assess drug use, but they're not a diagnostic test for addiction. However, these tests may be used for monitoring treatment and recovery.

For diagnosis of a substance use disorder, most mental health professionals use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment

Although there's no cure for drug addiction, treatment options can help you overcome an addiction and stay drug-free. Your treatment depends on the drug used and any related medical or mental health disorders you may have. Long-term follow-up is important to prevent relapse.

Treatment programs

Treatment programs for substance use disorder usually offer:

• Individual, group or family therapy sessions
• A focus on understanding the nature of addiction, becoming drug-free and preventing relapse
• Levels of care and settings that vary depending on your needs, such as outpatient, residential and inpatient programs

Withdrawal therapy

The goal of detoxification, also called "detox" or withdrawal therapy, is to enable you to stop taking the addicting drug as quickly and safely as possible. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis. Others may need admission to a hospital or a residential treatment center.

Withdrawal from different categories of drugs — such as depressants, stimulants or opioids — produces different side effects and requires different approaches. Detox may involve gradually reducing the dose of the drug or temporarily substituting other substances, such as methadone, buprenorphine, or a combination of buprenorphine and naloxone.

Opioid overdose

In an opioid overdose, a medicine called naloxone can be given by emergency responders, or in some states, by anyone who witnesses an overdose. Naloxone temporarily reverses the effects of opioid drugs.

While naloxone has been on the market for years, a nasal spray (Narcan, Kloxxado) and an injectable form are now available, though they can be very expensive. Whatever the method of delivery, seek immediate medical care after using naloxone.

Medicine as part of treatment

After discussion with you, your health care provider may recommend medicine as part of your treatment for opioid addiction. Medicines don't cure your opioid addiction, but they can help in your recovery. These medicines can reduce your craving for opioids and may help you avoid relapse. Medicine treatment options for opioid addiction may include buprenorphine, methadone, naltrexone, and a combination of buprenorphine and naloxone.

Behavior therapy

As part of a drug treatment program, behavior therapy — a form of psychotherapy — can be done by a psychologist or psychiatrist, or you may receive counseling from a licensed alcohol and drug counselor. Therapy and counseling may be done with an individual, a family or a group. The therapist or counselor can:

• Help you develop ways to cope with your drug cravings
• Suggest strategies to avoid drugs and prevent relapse
• Offer suggestions on how to deal with a relapse if it occurs
• Talk about issues regarding your job, legal problems, and relationships with family and friends
• Include family members to help them develop better communication skills and be supportive
• Address other mental health conditions

Self-help groups

Many, though not all, self-help support groups use the 12-step model first developed by Alcoholics Anonymous. Self-help support groups, such as Narcotics Anonymous, help people who are addicted to drugs.

The self-help support group message is that addiction is an ongoing disorder with a danger of relapse. Self-help support groups can decrease the sense of shame and isolation that can lead to relapse.

Your therapist or licensed counselor can help you locate a self-help support group. You may also find support groups in your community or on the internet.

Ongoing treatment

Even after you've completed initial treatment, ongoing treatment and support can help prevent a relapse. Follow-up care can include periodic appointments with your counselor, continuing in a self-help program or attending a regular group session. Seek help right away if you relapse.

Coping and support

Overcoming an addiction and staying drug-free require a persistent effort. Learning new coping skills and knowing where to find help are essential. Taking these actions can help:

• See a licensed therapist or licensed drug and alcohol counselor. Drug addiction is linked to many problems that may be helped with therapy or counseling, including other underlying mental health concerns or marriage or family problems. Seeing a psychiatrist, psychologist or licensed counselor may help you regain your peace of mind and mend your relationships.
• Seek treatment for other mental health disorders. People with other mental health problems, such as depression, are more likely to become addicted to drugs. Seek immediate treatment from a qualified mental health professional if you have any signs or symptoms of mental health problems.
• Join a support group. Support groups, such as Narcotics Anonymous or Alcoholics Anonymous, can be very effective in coping with addiction. Compassion, understanding and shared experiences can help you break your addiction and stay drug-free.

Preparing for your appointment

It may help to get an independent perspective from someone you trust and who knows you well. You can start by discussing your substance use with your primary care provider. Or ask for a referral to a specialist in drug addiction, such as a licensed alcohol and drug counselor, or a psychiatrist or psychologist. Take a relative or friend along.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, be prepared:

• Be honest about your drug use. When you engage in unhealthy drug use, it can be easy to downplay or underestimate how much you use and your level of addiction. To get an accurate idea of which treatment may help, be honest with your health care provider or mental health provider.
• Make a list of all medicines, vitamins, herbs or other supplements that you're taking, and the dosages. Tell your health care provider and mental health provider about any legal or illegal drugs you're using.
• Make a list of questions to ask your health care provider or mental health provider.

Some questions to ask your provider may include:

• What's the best approach to my drug addiction?
• Should I see a psychiatrist or other mental health professional?
• Will I need to go to the hospital or spend time as an inpatient or outpatient at a recovery clinic?
• What are the alternatives to the primary approach that you're suggesting?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your provider is likely to ask you several questions, such as:

• What drugs do you use?
• When did your drug use first start?
• How often do you use drugs?
• When you take a drug, how much do you use?
• Do you ever feel that you might have a problem with drugs?
• Have you tried to quit on your own? What happened when you did?
• If you tried to quit, did you have withdrawal symptoms?
• Have any family members criticized your drug use?
• Are you ready to get the treatment needed for your drug addiction?

Be ready to answer questions so you'll have more time to go over any points you want to focus on.