Behavioral intervention needed to manage substance use disorder

Special to the Sun-Gazette

In April’s column, we reviewed Chapter 3 of the surgeon general’s report, which discussed prevention policies and programs. This month, we review Chapter 4: “Early Intervention, Treatment and Management of Substance Abuse Disorders.”

If a person does develop a substance abuse addiction, receiving treatment is important. As the medical community has acknowledged, addiction to drugs or alcohol is very similar to other chronic illnesses such as heart disease or diabetes.

Chronic illnesses of any type usually can be managed with medication and/or other supportive therapies, which also include changes to fundamental behaviors and life choices. Therefore, treatment of substance abuse disorders should contain some form of behavioral interventions.

What is a behavioral intervention? Behavioral interventions such as those delivered in individual, group and/or family settings are designed to require patients to examine their beliefs and behaviors and decide to change.

These evidence-based programs are designed to increase a patient’s motivation to change their beliefs about themselves generally, and their ability to make changes or to work toward life goals. Most are designed to identify and change both behavioral patterns and abnormal thinking.

Initially, an individual must be screened to determine both the needs and the severity of the substance use disorder. Any treatment is designed to “reduce the major symptom of the illness and return the patient to a state of full functioning.”

Therefore, it is important to assess not only the level of substance abuse disorder but also those related health and social consequences that would interfere with the patient’s course of treatment or increase the risk of relapse, which could include housing, employment and increasing connection within the community.

For the most severe level, residential treatment appears to be the most beneficial, as the patient lives in a highly controlled environment with intensive daily services. Once complete, they then are referred to as “step-down” services, which are designed to “promote and encourage patients to independently manage their condition.”

For others, a combination of intensive therapy and medication-assisted treatment — such as methadone, buprenorphine or naltrexone — help to support the treatment and recovery process. These added medications, rather than being substitutes, have shown to assist patients to return to a healthy life without the withdrawal or craving that might occur from abstinence.

Unfortunately, most do not seek treatment until after some type of crisis. As with other chronic medical conditions, “detecting problems and offering a treatment after a crisis is not considered good medicine.”

The report recommends integrating screening into a general medical setting to make it easier to identify those in need of care and refer them to the appropriate level before overdose or entry into the criminal justice system.

With more than 25 million people living in long-term recovery, it is clear that treatment is effective. Next month, the report discusses the many paths to wellness.

The mission statement of Project Bald Eagle: A 501(c)3 non-profit organization that is leading coalition efforts to stem the tide of the heroin epidemic through education, prevention, treatment, enforcement and data monitoring.