Treatment and management of addiction encompasses the range of approaches aimed at helping individuals overcome addiction, most commonly in the form of DSM-5 diagnosed substance use disorders, or behavioral addictions such as problematic gambling and social media addiction. Treatment is one of the recovery pathways that individuals can follow to resolve their addiction and other related problems, as opposed to natural recovery, depending on how severe the addiction is. Treatment of substance use disorders can start with detoxification if needed, to manage physical and psychological health when severe withdrawal symptoms are expected to occur. Common addiction treatment therapies are counseling, cognitive behavioral therapy (CBT), medication-assisted treatment, twelve-step programs and other types of support groups, some of which in dedicated treatment facilities. Therapies address both the physical and psychological aspects of addiction, recognizing it as a chronic but treatable condition. Recent discoveries in the fields of neurological and biotechnology promise more effective treatments for addiction. Some studies on deep-brain stimulation show promising results, next to implants for opioid users. Also vaccine research is being carried out to improve treatment for addictions Effective treatment often includes a combination of medical, psychological, and social interventions tailored to the specific needs of the individual. A sociological approach to the treatment of addiction puts an emphasis on the social determinants of developing addiction to recovery and wellbeing. It considers the dynamic and reciprocal relationships that are of importance to the individual's experience. Unsuccessful treatment can happen because of discontinuation of treatment, with retention rates ranging from 17%-57%. The occurrence of one or more relapses, also account for unsuccessful treatment. The goal of addiction treatment is to reduce dependence, achieve partial or full abstinence and improve the quality of life by a process of personal growth, while making behavioral changes or changes to the personal environment that support sustainable recovery. The transtheoretical model (TTM) can be used to determine when treatment can begin and which method will be most effective. If treatment begins too early, it can cause a person to become defensive and resistant to change. The rate of successful lifetime recovery is around 50%, a metastudy on 415 reports (1868–2011) showed.
Behavioral therapy CBT proposes four assumptions essential to the approach to treatment: addiction is a learned behavior, it emerges in an environmental context, it is developed and maintained by particular thought patterns and processes, and CBT can be integrated well with other treatment and management approaches as they all have similar goals. CBT, (e.g., relapse prevention), motivational interviewing, and a community reinforcement approach are effective interventions with moderate effect sizes. Interventions focusing on impulsivity and sensation seeking are successful in decreasing substance use. Cue exposure uses ideas from classical conditioning theory to change the learned behavioral response of someone addicted to a cue or trigger. Contingency management uses ideas from operant conditioning to use meaningful positive reinforcements to influence addiction behaviors towards sobriety. Addiction recovery groups draw on different methods and models and rely on the success of vicarious learning, where people imitate behavior they observe as rewarding among their own social group or status as well as those perceived as being of a higher status. Substance addiction in children is complex and requires multifacted behavioral therapy. Family therapy and school-based interventions have had minor but lasting results. Innovative treatments are still needed for areas where relevant therapies are unavailable. Consistent aerobic exercise, especially endurance exercise (e.g., marathon running), prevents the development of certain drug addictions and is an effective adjunct treatment for drug addiction, and for psychostimulant addiction in particular. Consistent aerobic exercise magnitude-dependently (i.e., by duration and intensity) reduces drug addiction risk, which appears to occur through the reversal of drug induced addiction-related neuroplasticity. Exercise may prevent the development of drug addiction by altering ΔFosB or c-Fos immunoreactivity in the striatum or other parts of the reward system. Aerobic exercise decreases drug self-administration, reduces the likelihood of relapse, and induces opposite effects on striatal dopamine receptor D2 (DRD2) signaling (increased DRD2 density) to those induced by addictions to several drug classes (decreased DRD2 density). Consequently, consistent aerobic exercise may lead to better treatment outcomes when used as an adjunct treatment for drug addiction.
Medication
Alcohol addiction
Alcohol, like opioids, can induce a severe state of physical dependence and produce withdrawal symptoms such as delirium tremens. Because of this, treatment for alcohol addiction usually involves a combined approach dealing with dependence and addiction simultaneously. Benzodiazepines have the largest and the best evidence base in the treatment of alcohol withdrawal and are considered the gold standard of alcohol detoxification. Pharmacological treatments for alcohol addiction include drugs like naltrexone (opioid antagonist), disulfiram, acamprosate, and topiramate. Rather than substituting for alcohol, these drugs are intended to affect the desire to drink, either by directly reducing cravings as with acamprosate and topiramate, or by producing unpleasant effects when alcohol is consumed, as with disulfiram. These drugs can be effective if treatment is maintained, but compliance can be an issue as patients with disordered alcohol use may forget to take their medication, or discontinue use because of excessive side effects. The opioid antagonist naltrexone has been shown to be an effective treatment for alcoholism, with the effects lasting three to twelve months after the end of treatment.
Behavioral addictions
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