The Evolution of Addiction Treatment

Treatment for substance abuse and other addictions has changed significantly over the years. 100 years ago, addicts were believed to be morally degenerate, and the process of “treating” their addiction often amounted to little more than torture. Until research showed that addiction was a treatable disease of the brain, many addicts were also given prison sentences or shut away in asylums because it was assumed that they were permanently lacking in moral or mental substance. Unintentional and Deliberate Detoxification Some of these methods of “treating” substance abusers, such as imprisonment, had the unintentional result of allowing addicts to undergo detoxification. Without a true understanding of physical addiction and withdrawal, and without any means for easing the pain of detoxification, this process was often tortuous in and of itself. Those who imposed punishment on addicts or attempted to treat them largely assumed that addicts deserved to experience this pain due to their moral failings. As our understanding of substance abuse and physical dependency grew, detoxification became the primary goal of addiction treatment. Alcoholism was officially declared a disease in the 1950s, and by the 1970s lawmakers were recommending that alcoholics receive treatment rather than criminal prosecution. However, doctors still had a relatively limited understanding of the biological process of detoxification, and had relatively few ways of easing the pain of withdrawal. Eventually, doctors discovered medications such as methadone and bupropion that could be used to avoid withdrawal symptoms and allow for a relatively painless recovery. However, where addiction had once been considered a mental and moral problem, most experts now came to regard addiction as a physical affliction. Once patients had completed the detoxification process and were recovering from their physical dependency on a substance, they were considered to be cured of their addiction. The Rise of Comprehensive Treatment It took time for scientists to recognize addiction as a complicated brain disease involving both physical and mental aspects. While detoxification was once believed to be the only treatment necessary, health professionals now understand that detoxification is merely the first necessary step in the treatment of addiction. Addiction involves significant re-wiring of brain circuits, and it can take a long time to repair those circuits so that individuals no longer feel compelled to engage in drug-seeking behavior. The reward-fulfillment, inhibition, and memory areas of the brain are some of those that are greatly affected by long-term drug use. As a result, the most advanced treatments for addiction now available take a comprehensive approach to treating the disease. In-patient treatment facilities and other treatment programs now target both the mental and the physical aspects of addiction with goal of giving patients the tools to achieve long-tem sobriety. With a multidisciplinary treatment approach, patients will receive care for both the physical symptoms of withdrawal and any underlying physical health issues that may have contributed to the addiction or developed as a result of substance abuse. Where society once viewed the pain of withdrawal as “just desserts” for an addict, doctors now know that a painful withdrawal process can make patients less likely to achieve long-term success with their recovery. An important component of a multidisciplinary approach is also identifying and treating any underlying mental health conditions that patients may have. Many addicts turned to substance abuse or other harmful behaviors as a way to cope with untreated psychological or psychiatric disorders, and addicts are likely to return to those behaviors if these disorders are not identified and addressed. A long-term addiction can also give rise to mental and social difficulties that were not present before the addiction took hold. Addictions can damage social and work relationships, and give rise to low self esteem, depression, or other disorders as a result of addicts developing a negative view of themselves and their situations. Helping patients to regain the ability to be productive and maintain health relationships is also an important part of promoting long term recovery. In Recovery, Not Recovered One of the most significant changes in the modern approach to addiction is the understanding that addiction recovery is a life-long process. Addiction is a chronic illness, and addicts may need some form of care or support for much if not all of their lives in order to remain abstinent. Even former addicts who have achieved years of sobriety and no longer receive any form of care are still potentially susceptible to relapse if they deviate from their course. As a result, addiction specialists prefer to use the term “in recovery” rather than “recovered” to refer to former addicts, no matter how much time has passed since they achieved sobriety.

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