Whole Health Partnerships for Addiction Treatment
At Whole Health, we work closely with select addiction treatment centers in Delray Beach and Palm Beach County. We encourage, when appropriate, group therapy with other individuals in similar situations. This provides social reinforcement and help enforce substance abstinence and a healthy lifestyle. Group therapy can drastically improve long-term sobriety.
With our closely-monitored, individualized treatment plans we ensure that our treatment center partners guide our clients through other aspects that directly affect their recovery. These may include legal issues, family issues, and other social problems that require assistance. We will put you on the best path for you, depending on your individual needs and circumstances.
Having a physician or healthcare provider trained and experienced in drug and alcohol use disorders is vitally important in addressing your needs. While we try to provide and encourage non-medication solutions, they are not always adequate on their own for the individual suffering from addiction. Our caring staff evaluates for co-occurring psychiatric disorders including bipolar disorder, depression, anxiety, post-traumatic stress (PTSD), schizophrenia and others. We then analyze possible underlying metabolic issues in men and women that may be contributing to these disorders or patient’s addiction. This ensures our patients are physiologically in an optimal place to proceed with an effective and individualized treatment program.
If you, or a loved one suffers from drug, or alcohol addiction Dr. Ligotti of Whole Health in Delray Beach can help.
Give us a call (855) 965-1626 and start your out-patient opiate detox in Delray Beach. Out-patient addiction treatment allows you to continue working and be with family.
We can help you quickly discontinue dangerous narcotics without painful, miserable side-effects and without hospitalization!
Substance addiction is a chronic disease that is very difficult to control, regardless of the harmful, dangerous consequences it presents to a person. The United States is experiencing an overdose epidemic, both across the country and across multiple demographic groups. Addiction is a chronic disorder and occurs in many different forms.
Depending on an individual’s symptoms, circumstances and history, different treatment paths may be appropriate and take different lengths of time. Again, as with the treatment of all disease processes, treatment protocols must be individualized to the patient’s unique circumstances. Attempting to squeeze all people with a substance use disorder into one recovery plan, whether it be 12 step or MAT, will likely be ineffective in treating the addiction.
Drug overdoses killed 63,632 people in the US in 2016.1 All types of drugs, men and women aged 15 and older of all races and living in varying geographic locales were affected. Sixty-six percent of these overdose fatalities were related to the use of a prescription or illegal opioid drug.2
How The Brain Is Affected
By Drug Use
It has been determined that certain drugs can affect changes in the brain’s chemistry. These alterations make quitting substance use much more difficult than simply having the desire or willpower to do so. They can also lead to fatal errors, such as overdosing.
The brain has something known as the “reward circuit.” Humans feel joy when listening to music, after exercising, eating meals they love, and doing other activities from which they derive pleasure.
There is a chemical in the brain called dopamine. It is released by nerve cells and sends signals to other nerve cells in the brain. This neurotransmitter or messenger plays an important role in creating feelings of pleasure, reward, and the motivation to repeat certain behaviors. When a person takes certain drugs, this reward circuit part of the brain becomes filled with dopamine, causing feelings of euphoria and happiness.
When the brain’s reward circuit is flooded with dopamine, the message is sent to repeat the activity that led to this euphoric state. Soon, a person learns to take in substances that will replicate these feelings, and the brain adapts by requiring higher doses over time in order to duplicate the reward. In other words, a tolerance to the drug builds up and higher quantities are needed in order to achieve the same amount of pleasure.
Soon, brain cells in the reward circuit no longer provide the pleasure someone used to enjoy from simpler things, like food, exercise, social interaction, and hobbies. Instead, the brain adapts and wants to only find satisfaction or joy from the substance being used.
Addiction Is A Disease
Addiction has been defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite adverse consequences.
Research that studies how drugs affect the brain has led to important addiction treatment modalities than can help people return to sobriety and lead a productive lifestyle once again. Addiction is a chronic disease that shows some similarities to other chronic diseases, such as type II diabetes, cancer, and heart disease. All of these chronic illnesses are influenced by your environment and your genetic background.
Just as no one makes a choice to develop diabetes, no one chooses to become addicted to substances. Most chronic diseases are complex, with behavioral changes necessary in order to achieve treatment goals.
A diabetic must learn to change his or her diet in order to keep blood sugar levels in check. Someone with a substance use disorder must also make behavioral and cognitive changes to avoid relapse and overcome triggers that lead to relapse.
Just as a person has to make lifestyle adjustments in order to cope with cardiovascular disease, a person suffering from addiction needs to make healthy choices in order to be treated.
Someone with heart disease must eat a healthier diet, exercise more, know if there’s a family history of the disease, and keep cholesterol numbers down and seek treatment when needed. A person suffering from drug addiction must also engage in healthy activities, should understand their genetic disposition to addiction, learn coping strategies, and enter a treatment regimen that will lead to sobriety.
Harm Reduction Approach To Addiction Treatment
The main philosophy of harm reduction is to lessen the negative consequences associated with drug use while respecting the rights of people who abuse substances.
The goals of harm reduction are to boost the wellbeing and dignity of people and their communities that are affected by substance use. Harm reduction practices can lessen the impact that drug use has on certain behaviors. If the disease of addiction is unavoidable for some people, the philosophy of harm reduction is that it is not appropriate to push a person into abstinence if they are not open to it. When they are ready to withdraw from drug or alcohol use, medications should be available to ease symptoms, just as medications would be given to someone with diabetes or heart disease.
The central principles of harm reduction include the following:
Proponents of the harm reduction approach to addiction treatment speak to a person’s circumstances that may have led to addiction while addressing the addiction itself. The harmful consequences of addiction are minimized instead of completely being condemned. Advocating safer and managed use treatment plans that support medication use are elements of harm reduction therapy. In order to treat drug addiction effectively, multiple therapeutic tools are often utilized, with harm reduction therapy used to lessen the risks of drug use. Not every person suffering from substance use disorders will be able to comply with complete abstinence, although that is the ultimate goal.
Harm reduction places a premium on self-accountability, 12-step meetings, peer support, and self-reporting use of substances. Harm reduction programs have been shown to help prevent opioid overdoses with the use of the drug naloxone. This medication reverses opioid overdose by way of blocking the brain’s opioid receptor sites. Using harm reduction techniques can reduce instances of the dangers associated with alcohol abuse. Some people suffering from alcohol addiction are not prepared to go into recovery. Some strategies that relate to harm reduction include appointing a designated driver before drinking or planning one day of abstinence per week.
Other harm reduction techniques for addiction treatment include motivational interviewing, which lets a client explore reasons for changing habits and behaviors. This technique is used to build a relationship that will help in the move toward change, despite initial resistance to stop using drugs or alcohol. The main goal of drug addiction treatment is recovery and sobriety. This leads to productive functioning within families, among co-workers, and in the community at large.
Harm Reduction For Addiction Disease
Integrating a harm reduction approach to addiction treatment therapies is helpful for many people who wish to reduce the harm that substance abuse causes, though they may not be ready to completely abstain from their use.
Setting individual goals and going through the various levels of recovery at one’s own pace is at the heart of harm reduction. When used in conjunction with conventional treatment services, there is a greater motivation to achieve successful recovery.
Success Using Harm Reduction Treatment
Using a harm reduction approach to addiction recovery has shown significant progress from the time of entry into a program to a last follow-up assessment. Having strong social and psychological support within an encouraging organization helps users of substance believe more in themselves, helping them to move forward in life in a positive way.
A highly studied group in alcohol harm reduction programs is comprised of college students. One study found that with the use of a harm reduction program, students decreased their intake of alcohol by 40%-50%. The group had decreased their drinking from 14.8 drinks per week to 6.6 drinks for up to one year follow-up after the study ended.3
Successful treatment for addiction, however, needs to be continually evaluated, monitored, and modified, as relapses can and do occur. This does not add up to a failed recovery, but rather points for adjustment or alteration. When someone is being treated for cardiovascular disease, the treatment may be successful, but symptoms can come back if former activities and behavioral habits return.
Types of Addictions
There are different forms of addiction disorders, many of which lend themselves well to a harm reduction therapeutic approach.
Having an addiction to substances, such as stimulants or depressants, affect brain chemistry, which can quickly lead to dependency, cravings, and an inability to control the desire and need for these drugs.
Certain stimulants prescribed by physicians to treat attention-deficit disorder (ADD) and narcolepsy include:
- Dextroamphetamine (Brand name: Dexedrine)
- Dextroamphetamine/amphetamine combination (Adderall)
- Methylphenidate (Ritalin, Concerta)
These types of stimulants enable patients to have increased alertness, attention, and energy. However, they are sometimes abused and taken either illegally or in doses other than prescribed in order to achieve a high.
Known on the street as “uppers”, “speed” or “vitamin R”, stimulants increase the brain’s release of dopamine and norepinephrine. Dopamine works within the reward circuit to reinforce the good feeling it produces, while norepinephrine acts on your circulatory system, blood sugar, and breathing.
A person can become addicted to and overdose on stimulants. Someone with an addiction to stimulants can get treatment through a facility that uses behavioral and other therapies, including harm reduction motivational incentives.
Drugs that affect the central nervous system include sedatives, tranquilizers, and hypnotics. These medications slow down brain activity. They are often prescribed for anxiety, panic attacks, muscular spasms, and sleep disorders. There are different classes of depressants, each listed here with their generic and brand names.
Benzodiazepines consist of drugs such as:
Sedative Hypnotics often used for sleep disorders:
Barbiturates are depressants, such as:
Taking depressants over a long period of time, even with a doctor’s prescription, can lead to a tolerance. You will need higher doses of the same medication in order to achieve the same effect, leading to addiction. Sudden withdrawal from these drugs can lead to severe symptoms that may become life-threatening.
Someone suffering from substance use disorder requires either inpatient or outpatient therapy in order to regain their wellbeing. Harm reduction approaches using behavioral counseling to guide the way a person thinks about their situation, and is often successful in treating depressant addiction.
Several types of behaviors bring about short-term rewards that can possess a person to continue engaging in this behavior again and again, despite the negative consequences involved.
Similar to substance use disorders, behavioral addictions feature an inability to resist an impulse or temptation to do something that will harm oneself or others. A pattern of such repetitive behavior that is difficult to stop is known as a non-substance or behavioral addiction.
Up to 30 million Americans of all ages and genders suffer from an eating disorder. Every 62 minutes, someone dies as a result of an eating disorder. Thirteen percent of women over the age of 50 display eating disorder behaviors.4 This type of behavioral addiction falls under different diagnoses, such as anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder.
In the US, almost 10 million people or 2.6% of the population has a gambling addiction issue. Young people aged 16-24 show the most susceptibility to acquiring an addiction to gambling.5
Clinically called kleptomania, stealing can be a serious impulse control disorder. Whether a person is repeatedly shoplifting or stealing from strangers, friends and family, it is a behavioral addiction that requires treatment when done out of an uncontrollable urge without any planning or need for the stolen items or money.
Care and Treatment For Addiction
A continuum of care facility for addiction rehab provides various levels of care to their clients. Clients should enter treatment at a level that is appropriate to their needs at the time. They can then either step up or move down to another level, making their way along the continuum.
Detox is usually the first level of care for clients with substance use disorder who have been properly evaluated, are stabilized, and ready for treatment. Detox can be undertaken in a variety of settings and at different levels of intensity, depending upon the needs of the client.
The main goal of detox is to cleanse the body of all toxins and harmful substances. Only then is a person ready and able to continue along the steps needed to complete the recovery process.
Medications are often given to ease the painful symptoms that accompany withdrawal from substances, which is the first step in the detox process. For instance, if someone is suffering from an addiction to heroin, methadone may be given as they detox from this dangerous opioid. This is known as medication-assisted therapy (MAT).
Not everyone requires an intense detoxification period with MAT. Depending upon the type of substance being abused, the length of time of the ongoing addiction and other factors, sometimes non-medical detox can be utilized. Alternative therapies rather than drugs are used to lessen withdrawal symptoms, with medically trained staff available to supervise the process.
Residential Treatment for Addiction
The main goals of residential treatment for addiction using a harm reduction approach are to:
- Encourage abstinence from substance and behavioral addictions
- Empower individuals to make the changes they want to make in their lives for themselves
- Provide a personal approach, offering various avenues and choices toward change, whether through abstinence or a move towards controlled or safer use
The length of stay in a residential treatment program varies with each individual. Successful outcomes are dependent on an adequate amount of time spent in treatment. On average, residents in an in-patient program stay between 30 and 90 days, with 12 months usually the minimum for someone undergoing methadone maintenance.
A daily schedule in residential treatment after detox has been completed will resemble the following:
Individual Counseling Session
Alternative Therapies (yoga, massage, meditation)
Exercise (to boost mood and reduce cravings)
Group Discussions and Socialization
The types of therapies used in residential treatment will depend upon the individual’s needs and the substance or behavioral addiction being worked on. Therapists work with clients on setting goals in order to bring about desired behavioral changes. Stress reduction exercises such as yoga, learning coping skills to deal with cravings, and learning how to manage drug use by increasing safety while considering abstinence are hallmarks of the harm reduction approach.
Those who benefit most from residential treatment using harm reduction therapies are those who are not yet ready for complete abstinence from drug use yet know that they will eventually get there.
Intensive Outpatient Program (IOP) For Addiction
Obtaining treatment for addiction on an outpatient basis is an alternative to full-time residential treatment. In this setting, a client goes to a facility for a number of therapy sessions on a daily or weekly basis. The duration of each session is typically lengthier than those for inpatient residents. IOP clients remain living at home, in their own familiar community.
The goals of IOP are to help individuals learn how to manage relapse in the early stages of recovery. These include coping strategies, establishing social and psychological support systems, and investigating social, psychological, and emotional issues that deal with addiction and each person’s goals for abstinence or moderation.
Stigma-free reduction counseling, medically assisted therapies, overdose response training, and involvement in a support group are part of a harm reduction approach in an IOP setting.
The average length of involvement in an IOP program is about 12-16 weeks. A daily schedule of services may include some of the following:
- Group therapy session
- Individual therapy
- Family therapy
- Medication management
After the IOP program is completed, continuing care services similar to inpatient programs are usually offered in this transitional period of recovery. Those who have a strong support system at home usually benefit the most from an IOP program.
Outpatient Program For Addiction Treatment
An outpatient addiction treatment program is a bit more flexible with the scheduling of sessions and meetings than an IOP. These outpatient programs are best for those who need to continue going to work or school or have family obligations that cannot be changed easily.
As an outpatient, clients are also usually less dependent on substances and have been using drugs or alcohol for a lesser period of time. They also have a very supportive home or family environment. The goals of outpatient therapy are similar to those of IOP, with the same types of treatment options.
Aftercare For Addiction Treatment
The most important goal of an aftercare program is help with relapse prevention and self-care. The average length of aftercare will vary by the individual but will generally be several weeks. Regular weekly therapy sessions help with coping with stress and triggers for relapse.
Support services can be continued for months or years after treatment is completed on an inpatient or outpatient basis, depending upon the need for support.
When a person completes treatment, a transition to community care is next. Maintaining abstinence at this point is important, and participating in a community care program contributes to positive, lasting outcomes.
Community care may consist of taking part in:
- A 12-step support group
- Vocational training
- Recreational therapy
- Family therapy
A sober living home is typically a group residence for those who are in recovery from addiction. There are usually house rules to follow and chores assigned to each person. The goal of moving to a sober living home is to maintain sobriety after a stay in a residential recovery facility. It is a good transitional care environment to help people maintain sobriety among others like themselves. From sober living, residents then move on to independent living.
Most people remain in a transitional sober living home from 90 days to 18 months, with an average length of stay being 5 months. Living in a sober living environment typically involves adhering to an individualized schedule.
A usual day may entail:
- Waking up and going to sleep at the same time every day
- Engaging in a personal therapy session
- Going to a family counseling meeting
- Attending a 12-step meeting
- Going on job interviews
- Having house meetings
- Completing assigned chores
Effectiveness of Medically Assisted Treatment (MAT)
From 1999 to 2017, over 700,000 Americans have died from drug overdose. In 2017 alone, about 68% of the 70,200 overdose deaths that year involved an opioid drug. In the same year, deaths due to legal and illicit opioid (such as heroin) overdoses were 6 times higher than the reported fatalities in 1999.6
MAT utilizes medications such as methadone and buprenorphine to treat opioid addiction disorders. It is a very effective therapeutic tool, especially when combined with behavioral counseling.
What To Look For In a Treatment Provider
When deciding to choose a treatment provider that participates in harm reduction therapies, ask the following questions:
Collaborative Healing between Addiction Treatment Centers and Suboxone Clinics
Having an addiction treatment plan that keeps all practitioners including clinics, Doctors and private clinicians “in the loop” is extremely important to the success of the person in recovery. Since drug addiction is too complex and multi-factorial to be treated with any individual modality. A comprehensive, “holistic” approach incorporating behavioral and medical intervention is often the most effective approach to help motivate and propel participation of a person within their recovery.
This is extremely important to have qualified physicians monitoring progress because they provide proven strategies for coping with cravings, providing education and tools to avoid relapse. They also help individuals learn from relapse if it occurs and get back on their journey. Behavioral therapies are vital to improving family dynamics (all family members need to be involved in recovery,) professional and personal relationships, overall communication and in some cases parenting skills.