The abuse of alcohol or street drugs is a problem that effects an estimated 10% of the population. The difference between casual use of substances for recreational purposes and abuse and dependence is one of degree. The pattern and frequency of use and the impact the use is having on the user's lifestyle needs to be taken into consideration along with the presence of a withdrawal syndrome. In general, daily use of alcohol in any amount is cause for suspecting abuse and dependency. Weekly use of drugs is cause for a similar suspicion. Of course, all street drug use is illegal and should be taken into consideration in assessing a problem pattern. If a person is missing work or school, in debt, in legal trouble (arrested for possession, DWI etc.), arguing about use with family, withdrawing from family and friends, keeping late hours or losing weight then dependence should be considered.
Treatment starts with the user admitting that there is a problem. Typically users deny this and believe that they are in control of their consumption. Often family and legal authorities must act decisively to focus the user's attention on their problem. For family members and friends there is a fine line between being supportive and being enabling.
Detoxification is indicated in cases of heroin addiction and long standing alcohol abuse. Cocaine and marijuana use does not require detox. Twelve step programs are the most common mode of post-detox treatment. Group and individual therapy is also of value. A behavior therapy technique, called Exposure Response Prevention (ERP®), is a new method for helping a patient learn to manage their substance cravings and impulses to use. Medications such as depakote and Revia may help prevent relapse in some cases. Depression and anxiety symptoms can be reduced with medication, cognitive behavioral psychotherapy and training in relaxation methods. Ongoing support groups such as AA and NA are very helpful in the prevention of relapses. Most patients will go through several rehabilitation cycles before they free themselves of addictive behavior. Relapse is part of the treatment process.
