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When people realize their substance use has to change, many ask the same first question: How can I start to make that change? Some are able to make changes on their own, but many benefit from seeking help.
There is no "one-size-fits-all" approach to addiction treatment. People's needs vary. They depend on the severity and type of addiction problem, on the support available from family, friends and others, and on the person's motivation to change. Just as people's needs vary, so too does the help available.
Meeting with a trained counselor for an addiction assessment is a good way to start looking for help. The assessment helps to identify problems and strengths, and to determine what approach and level of support best suits each person.
If you decide to seek treatment, find a program that fits your needs and your way of thinking. The information in this chapter can give you some ideas about what to look for, and what questions you can ask when contacting treatment providers.
It can be hard to take the first step in finding a self-help resource, picking up the phone or going to a treatment service. But remember, you are not alone. Just making that first move is an important step toward change.
Some people with substance use problems are able to make changes on their own using self-help materials. In general, self-help books and websites help people to:
The oldest and largest self-help organization is Alcoholics Anonymous (AA), which was founded in the 1930s. AA views addiction as a disease that requires lifelong abstinence from all substances. Today, there are many self-help groups for people with substance use problems, with a variety of philosophies and approaches. Some are modelled on the 12-step approach of AA. Others accommodate people who just want to cut down on their substance use. Examples include Cocaine Anonymous (CA), Double Recovery Initiative (for both addiction and mental health issues), Moderation Management (MM), Narcotics Anonymous (NA), Nicotine Anonymous, Secular Organization for Sobriety (SOS), Self Management and Recovery Training (SMART Recovery) and Women for Sobriety (WFS). Many of these groups are available in an online support group format (see Resources for websites).
In addition, consumer/survivor initiatives, drug users' groups and other examples of grassroots activism, advocacy and support are available in many communities.
For many people with substance use problems, abstinence might be the most desirable goal, especially in the eyes of their families and some treatment providers. In contrast, the harm reduction approach offers other ways to reduce the harm of substance use, both to the person who is using and to his or her community.
Some examples of harm reduction strategies include:
For people who are dependent on heroin or other opioids (e.g., codeine, Percodan, OxyContin), effective treatments are methadone or buprenorphine. These medications are substituted for the opioid drug of concern. They prevent withdrawal and reduce cravings, without causing a person to get high. People who are stable on these medications can work, go to school and drive a car. Treatment usually lasts at least a year but may continue for longer, sometimes for many years.
Medications to treat other types of addiction are limited. One is naltrexone (Revia), which can reduce cravings to drink in people who are alcohol dependent (naltrexone can also be used to block the effects of opioids). Another is disulfiram (Antabuse), which causes people to feel sick and nauseous if they drink alcohol.
So far, there are no medications to treat addiction to cocaine or methamphetamine. For more information on medication options, talk to your doctor.
Counseling comes in a variety of forms, including individual, group, couple and family therapy. Counseling generally aims to:
A holistic approach to treatment
Many programs offer a variety of other supports and services, including information and counseling about:
Programs that can't offer help in all of these areas can often refer you to another service that can help. Also, treatment providers can act as advocates in linking you to needed services and programs.
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