Substance Use Disorder Treatment

After someone decides that they are ready for treatment, the first step is for that person to receive an assessment. Getting an assessment is important because it determines what kind of treatment service is best for them, to get the help they need! Once that person understands the kind of treatment they need, they should contact treatment centers in  Alabama. You can access an updated list of treatment centers by downloading the Connect Alabama app.

In some cases, there may be a waitlist for a treatment program. It may be useful for people waiting to call the person or agency that has completed their assessment and ask if they can recommend other treatment programs or set up other services while they wait.

The ROSS 24/7 helpline is always available to help people interested in starting treatment or their loved ones. They connect them with a peer specialist in recovery. They can provide support or answer questions about seeking or starting treatment: 1-844-307-1760.

Although each treatment program is different, the basic ingredients are similar. One can expect services like individual, group, and family counseling. The professional who helps you with your assessment can explain what the treatment program will look like and what you can expect!

The most common treatment programs are explained within this application under the “Types of Treatment” section.

In all treatment programs, there are common types of therapies and techniques used including Cognitive-Behavioral Therapy, Motivational Interviewing, Motivational Enhancement Therapy, and more.

You can find explanations of the most common therapies and techniques below:

Cognitive-Behavioral Therapy:

Cognitive-Behavioral Therapy, or CBT, is one of the most used therapy for substance use disorders.

CBT is a one-on-one therapy method where a person is alone with a therapist and based on the idea that habits, like substance use, are influenced by how they are learned. So, if a person notices and understands why they are using a substance, they can use different skills taught in therapy to help stop their use.

In CBT, a person will work with a therapist to see the pros and cons of their substance use. Then, the person will track their behavior to recognize cravings and risky situations that make them want to use substances.

In therapy, they will learn coping skills to help when they are in risky situations or want to use substances. For example, Timmy goes to therapy to help him understand why he is drinking alcohol more than he used to. After talking to his therapist about CBT, he notices that he gets lonely and bored before he begins to drink. He talks with his therapist, and they decide that when Timmy gets lonely and bored, he should find other things to do like go hang out with friends or go to the gym. CBT is shown to treat problems with alcohol, marijuana, cocaine, methamphetamine, and nicotine. Research shows that skills people learn in CBT help their lives even after they end treatment.

Motivational Interviewing:

Motivational Interviewing, or MI, is a technique therapists use to push people toward changing harmful behavior like substance use. This technique is centered around respecting the client’s behavior while working together to change the client’s mind about their substance use. The therapist is to use a guiding style of communication that sits between good listening and giving information to assist the person in becoming empowered to draw out their own meaning and importance for change.

Motivational Enhancement Therapy

Motivational Enhancement Therapy, or MET, is used to help people move from being uncertain or uninterested in changing their substance use to be ready to start treatment. The goal is not to guide a person through their recovery but to motivate them to change their present way of life. MET is typically done one-on-one with a therapist where they give an assessment of their substance use and mental health then asked to participate in 2 to 4 sessions.

In these sessions, the person gets feedback about their assessment results, and talk to the therapist about their substance use and desire to change. Then, the therapist uses motivational interviewing to increase the person’s desire to change. After, the therapist helps the client build a plan to change their substance use by exploring coping skills to utilize when they are in a situation with drugs or alcohol.

In the later sessions, the therapist sees how much the person has changed, reviews coping skills taught in earlier sessions, and encourages the person to stick to their plan to change.

MET is best for helping encourage substance users to recognize reasons for entering treatment instead of changing their substance use patterns. MET is most commonly used to treat disorders with alcohol, marijuana, and nicotine.

Contingency Management

Contingency Management, or CM, is when people recieve rewards when they do not use drugs or alcohol, and includes different types:

Voucher-Based Reinforcement (VBR)

In this type of CM, when a person has a clean drug test, they are given a voucher. These vouchers are like money and used in exchange for food, movie tickets, and more. The more clean drug screens a person has, the more value vouchers will have.

This type of CM is best for people who have problems with opioids or stimulants.

Prize Incentives

This type of CM uses cash prizes instead of vouchers. When a person attends their therapy sessions, reaches one of their treatment goals, or has a clean drug test, they can draw from a bowl to get a cash prize.

Prize incentives is best for people who have problems with stimulants, opioids, marijuana, and nicotine.

12-Step Facilitation Therapy

12-Step Facilitation Therapy is when a therapist encourages a person to get involved with a 12-step group.

Studies have shown that group therapy is great for recovery because people share their experiences with others who understand and have support from a community.

Examples of common 12-step groups are Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

In therapy, the therapist talks about the three main ideas of 12-step groups: acceptance, surrender, and active involvement. Acceptance means the person must accept that they are powerless over drugs or alcohol. Surrender means the person must commit themselves to a higher power. Active involvement means the person must become part of the 12-step community by attending meetings and getting a sponsor.

Family Behavior Therapy

In Family Behavior Therapy or FBT, the therapist focuses on the substance use disorder and other problems the person might have like unemployment or family conflict. This is done by the therapist helping the person make a behavior contract where the person agrees to change some behaviors, like drinking, by a specific date.

Once the behavior is changed, the person gets rewarded with prizes and vouchers like contingency management.

FBT is with the therapist, the person with the substance use disorder, and at least one loved one. The therapist looks over the behavior contract and urges the loved one to use skills that will help minimize conflict at home.

Multisystemic Therapy

Multisystemic Therapy, or MST, is best for substance-using children or teenagers. The goal of MST is to look at all the factors that have led to bad choices and substance use. Some of these factors can include character traits, family, friends, school, and neighborhood. MST is a therapy used in intensive outpatient treatment.

Multidimensional Family Therapy

Multidimensional Family Therapy, or MDFT, is best for substance-using children or teenagers. In MDFT, the therapist sees how the teenager’s drug use is affected by many different settings (like school, home), so the best way to address the substance use is to change behavior in each. In addition, the therapist and teenager work on learning life skills to help with stress, and the therapist have similar meetings with the family.

Individual Therapy

Individual therapy is counseling one-on-one with a therapist. The therapy sessions focus on personal problems and the mental and emotional needs a person may not be comfortable talking about in group. Therapy can help people make sense of their emotions and problems and how best to cope with stressors. In individual therapy, a person can expect to meet with the same therapist for a long period of time. In therapy, a person can set goals and uncover solutions that will help their recovery. Individual therapy is also helpful for stopping drug use and talking about other problems that may add stress such as unemployment or relationships with other people. Most people find it useful to their recovery to continue individual therapy even after leaving treatment.

Group Therapy

Group therapy gives people the chance to share their stories and struggles with other people. Group therapy can provide people with peer support and help them to feel more connected to others and less alone. Groups usually have about 6 to 10 people with 2 therapists who help guide discussion. Also, groups connect group members with others in recovery and can often create a community of support. Unlike family therapy, most members in group therapy will probably not have any relationship outside of group. Studies have found that group therapy can be just as effective as individual therapy. Group therapy can teach healthy coping skills, educate members on recovery, encourage members to share their story and learn skills to help them in everyday life.

Educational Services

Educational services are helpful for people in recovery who want to go back to school or are currently in school. These services help a person continue schooling even in treatment.

Vocational Services:

Vocational services help people decide which jobs are the best fit for them. These services help people get job skills, create a resume, and find employment.

Life Skills

Life skills are best for young adults to help them learn how to cope with the stress of life. The goal of life skills is to help build self-esteem and help teens manage their recovery.

Mental Health Treatment

Mental health treatment is for people who are also dealing with another or co-occurring mental illness. The best way to treat co-occurring disorders is to treat both at the same time but address them separately.

Family Services

Family services are for family members who have a loved one in recovery. Family Services help family members understand addiction is a disease and help the family understand what their loved one will get out of treatment.

Continuing Care

Continuing care is suggested even after a person leaves their treatment program. Continued care helps people take the skills they learned in treatment and apply them to their lives outside of treatment.

• The therapist will ask open-ended questions to find out a person’s perspective and ideas about change.
• They will affirm a person’s strengths and abilities.
• They will listen reflectively by repeating what a person has said to make sure it has been understood.
• They will finally summarize what a person says to reflect back to them the main idea of what they are saying.

**GOAL: Resolve any doubt or hesitancy and move forward with change**

Financial concerns should never stop people from getting treatment. There are a few ways to get evidence-based treatment without insurance, like state or federal programs and payment aid options.

If someone does have insurance, their provider is required (by law) to financially cover the cost of treatment.

If someone does not have insurance, there are Alabama Department of Mental Health associated treatment facilities where payment is based on their income and their ability to pay.

If payment and/or insurance is a big concern of yours, here are some tips for dealing with insurance companies for treatment:

1. Call your insurance provider to see who is in their network.
2. It is possible that your insurance will not cover the type or length of the program that is best for your needs.
   • In these cases, you should speak to your provider, or someone at the center, about the best options for your situation.
3. In rare cases, if there is no coverage, you may contact the Alabama State Insurance Board Commissioner.

Searching for the right treatment program for you or a loved one may seem overwhelming. It is helpful to know what to look for in a high-quality program. Here are some good signs to look for:

• Evidence-based behavioral health therapies are used in this program.
• Medications are available for MAT (medication-assisted treatment)
• The program is certified by the state of AL.
• The program addresses mental and physical health needs.
• Clients/patients can be tested for HIV/AIDS, hepatitis B and C, TB, and other infectious diseases.
• The program has a long-term strategy to support recovery even after the person has left the treatment center.
• The program is available for individuals who need treatment right away.
• There are personal treatment plans available because no one treatment is right for all.
• The program provides a minimum of 3 months of treatment.

An assessment tells someone which type of treatment is best for them. 

A common type of assessment used is SBIRT. SBIRT stands for screening, brief intervention, and referral to treatment. It is a screening technique used in primary care settings by doctors. When a person goes to see their doctor because they are sick or need a checkup, the doctor will screen them for risky drug and/or alcohol use. SBIRT catches early risky substance use that can develop into a substance use disorder later in life. This is a good technique to use to find a person who may be using alcohol or street drugs/prescription medications in ways that are harmful to their health. The patient will answer questions about mental health symptoms and drug and/or alcohol use. Then, the doctor will discuss how this can affect their health and what services may be right to deal with the impact.

If a person is in treatment for less than 90 days, the treatment will be much less effective. In fact, people who stay in treatment longer than 90 days are more likely to stay in recovery and are less likely to relapse.

Treatment is personalized, meaning it is unique for each person. Because of this, every person may stay in the same program for different lengths of time and will all receive different types of services.  Also, treatment does not just stop one day; it should decrease in intensity over time.

There are two categories of treatment: outpatient and residential. Within these categories, there are several types of treatment programs. The intensity of the treatment program determines the time required and what someone will do in treatment. Program intensity ranges from low to high.

In outpatient programs, a person will go to treatment during the day; but will live at home. These programs are not recommended for people who have substance-using family members at home, do not have a strong support system outside of treatment, have experienced relapse, have been a victim of abuse or trauma, or have a severe substance use disorder. The following are types of outpatient programs from the lowest intensity to the highest intensity.

Outpatient 

Outpatient is at a low to medium-intensity program, and attendees are not required to stay overnight at the facility. Individuals attend treatment anywhere from 1 to 9 hours a week, and treatment can be offered at night or on weekends so people can stay in school or go to work. Although they are often less intensive than residential programs, outpatient treatment often costs much less than residential treatment. In most outpatient programs, the most common service is group therapy. Also, some programs are designed to help people with medical issues or other mental health problems and substance use disorders.

Intensive Outpatient Program (IOP) 

Intensive Outpatient Programs (IOPs) range from medium to high-intensity, and attendees can live at home. Individuals attend anywhere from 9 to 19 hours of treatment a week. This option is better for individuals with multiple issues, like a substance use disorder and trauma, or for individuals who have tried a lower-level program before, but it was unsuccessful. IOPs are a great option for people who have family or work commitments, and they cannot leave their lives behind to go to a residential treatment facility. Throughout the week, in most IOPs, people will go to group and individual therapy. Most encourage participation in a 12-step program, and most clients go to the facility 3 to 4 times a week for treatment.

Partial Hospitalization Program  

Partial Hospitalization Programs (PHPs) are medium to high-intensity programs. Programs require individuals to attend treatment anywhere from 4 to 8 hours a day. The difference between PHPs and IOPs is that PHPs are much more time-consuming. These programs are often best for people who need intense, structured treatment and/or have a co-occurring mental health problem (such as having a substance use disorder and anxiety) but want or need to stay at home.  Also, these programs can be used as a “step down” for people who have just left residential treatment but are not ready to go back to their daily lives entirely. The goal of partial hospitalization programs is to provide complete care without removing a person from the freedoms of their own home. Most PHPs are run by medical staff or certified addiction counselors. Common services in PHPs are behavioral therapy, individual therapy, group therapy, support groups, art therapy, and fitness and nutrition.

In residential treatment programs, a person will go to treatment and live in the facility with other residents. The following are types of residential treatment programs:

Residential 

These programs range from medium to high-intensity. People stay at residential treatment centers anywhere from 2 weeks to 1 year. In these programs, residents receive care and 24-hour supervision with highly structured schedules. In most treatment programs, individuals move through phases in the program where the

longer they have been there, or the better they are doing in treatment, the more freedom they will have. Because these programs provide around-the-clock care, they often have many different types of staff members that may include doctors, nurses, psychiatrists, licensed counselors, case managers, and more.

7:00am – Breakfast
7:45am – Meditation
8:30am – Physical Wellness Training
10:00am – Behavioral Health Group
11:00am – Relapse Prevention Group
12:00pm – Lunch and Reflection Time
1:00pm – Nutrition and Wellness Group
2:00pm – One-on-One Therapy
3:00pm – Expressive Therapies in Recovery
4:00pm – Therapeutic Community Group
5:00pm – Dinner
6:30pm – Recovery Meeting
7:30pm – Clean & Sober Structured Activities/Recreation
10:00pm – Lights Out

Therapeutic Community Model: 

Therapeutic community model is the best known and used residential treatment model.

The planned length of stay for people is 6 to 12 months.

The goal of this treatment model is to teach each resident new skills and practices that will help them be productive members of society by learning from everyone at the treatment facility, including other residents to help with their transition outside of the residential facility..

Inpatient 

These programs are high-intensity programs. Most of these programs offer both detox and treatment. These programs are similar to residential but are highly structured (i.e., very set schedules) and often residents stay longer. This type of treatment is best for people at high risk of experiencing withdrawal, who have experienced a relapse, have tried less intensive levels of treatment but were not able to stay sober, have serious medical conditions, or severe mental disorders that need addressing as well as substance use.

Recovery Housing 

Recovery housing is an option for people who want to live around others who are also new in recovery. Recovery homes are a safe place for people moving from treatment back to their daily lives. Recovery homes gives people another place to go to after treatment instead of returning to an old environment where they might be around substance use. Recovery houses help residents make their living cost-effective, provide a community of sober residents, and provide an environment that supports their long-term recovery. Studies have shown that most people who go to sober living homes after treatment are less likely to relapse.

Oxford House:

Oxford House is the most common type of sober living. This type of sober house highlights peer support and is run by residents. Residents do not have to do any type of treatment but 12-step support groups, like AA, are common in most facilities. Potential new members attend an interview conducted by current residents who then vote to determine their acceptance. Residents also choose officers, pay their own rent, and break up chores.

Alabama Alliance for Recovery Residencies (AARR):

The Alabama Alliance for Recovery Residences (AARR) has recently been certified as Alabama’s affiliate of the National Alliance  of Recovery Residences (NARR). AARR-certified recovery homes give Alabamians in recovery a home environment that includes a caring community, accountability, and support to help individuals transition from treatment to the outside world.

Medication-Assisted Treatment (MAT) 

Medication-Assisted Treatment, or MAT, are special programs that combine medication with counseling to help people who are physically dependent on specific substances. Substances effective to treat by using MAT are opioids (like heroin) and alcohol. In these programs, people take medication to help with physical dependency and withdrawals and get counseling and other services they need. There are several types of medications, but they are used to lessen cravings and help withdrawal symptoms. Studies have shown that MAT programs are safe, profitable, reduce overdoses, increase treatment retention, and improve social functioning. The goal of MAT is for people to make a full recovery and independent and live a full life.

While some people think MAT treatment is switching one drug for another, these medications are given in monitored environments. If the person uses the medication as prescribed, just like a prescription written for a cold, it is safe and effective.

These medications have a different effect than opioids like heroin. They slowly create steady levels of the drug in the brain, so the person does not get the reward of using, which makes them want to use less.

If a person uses these medications, then uses an opioid, the opioid does not have as much of a rewarding effect. Some of these medications, like buprenorphine and suboxone, have a limit on how high a user can get when using these medications, so they cannot be used to replace previous drugs of choice.

The following are medications for a person with an alcohol use disorder:

Acamprosate 

Acamprosate is best for people in recovery who have stopped drinking and want to avoid drinking again. Because long-term use of alcohol harms brain function, Acamprosate helps the brain function normally. Acamprosate does not work for people who have not stopped drinking heavily or also misuse other drugs. Another name for Acamprosate is Campral.

Disulfiram 

Disulfiram makes a person sensitive to alcohol. About 10 minutes after drinking alcohol, a person will experience heavy nausea, vomiting, headache, and chest pains that last an hour or more. When a person has this bad reaction to drinking, it makes them less likely to drink again. Another name for Disulfiram is Antabuse.

Naltrexone 

Naltrexone blocks the reward of being drunk. Because most often, a person drinks heavily to experience intoxication, they are less likely to drink if they cannot get drunk. This drug reduces alcohol use and makes the individual remain motivated to not relapse. Other names for Naltrexone are ReVia, Vivitrol, and Depade.

The following are medications for a person with an opioid use disorder:

Buprenorphine 

Buprenorphine reduces opioid cravings. Buprenorphine has a limit, or ceiling effect, on how high someone can get when using it, so it has a lower overdose potential. Another name for Buprenorphine is Subutex.

Methadone 

Methadone reduces opioid cravings and blocks the reward of using opioids. Methadone stays in the body for a long time. Because it reduces cravings, it keeps the individual stable and focused on recovery. Individuals will need to remain on Methadone for 12 months for it to work as prescribed

Naltrexone 

Naltrexone blocks the reward of opioid use, so a person does not feel high and has fewer cravings. Like how it is used for alcohol, if the user cannot get high, they are less likely to use. Other names for Naltrexone are ReVia, Vivitrol, and Depade.

Suboxone 

Suboxone is a combination of buprenorphine and naltrexone. By combining these two medications, suboxone lessens cravings. It cannot be used to get high by blocking the reward of opioid use.  Because of the buprenorphine, there is a limit, or ceiling effect, on the drug’s effect, so users cannot get high as if they were using opioids like heroin.

Detoxification, also called detox or withdrawal management, is when the body is cleared of drugs.

Detox is not treatment. It only helps the physical withdrawal symptoms from substance use.

Detox is only used for people who need to safely manage withdrawal symptoms when they stop using alcohol, benzodiazepines, and/or opioids, before going to treatment.

Going to a monitored facility to detox from these substances is necessary because withdrawals can be fatal.

During or before leaving detox, a person should complete an assessment to get a recommendation and referral for treatment.

Most times, a person will go to treatment after detox. In treatment, they are given a treatment plan to best address the challenges they have because of their substance use or that led to their use.

Examples of Triggers

• Stress is one of the highest causes of relapse. Many people use their substance of choice as a way to cope. While someone cannot avoid everything stressful in their life, they can be aware of what stresses them out.
• People or Places. People someone drank or did drugs with or places they went to use can remind someone of their addiction. Finding other places and new people in recovery to hang out with can help someone cope with this trigger.
• Negative or Challenging Emotions. Often people with a substance use disorder use substances to cope with negative feelings, like sadness or anger. It may be useful for someone to find another way to release those negative emotions, like talking to a therapist or meditating.
• Seeing or Smelling Others Use. Watching people drink in a bar or seeing a needle might remind someone of their addiction. In these moments, it may be helpful to focus on the positives of a new life in recovery or find something else to do like, a new hobby.
• Times of Celebration. In positive situations, like birthdays or holidays, it is common for someone in recovery to think they can handle one drink or hit, but people with substance use disorders struggle with stopping. One beer turns into 6, so it is helpful to have a friend in these situations to hold them accountable.

Many people wrongly believe that completing a treatment program is the end of recovery. The truth is that recovery is an ongoing process that takes time and effort.

When returning home, it is important to develop a plan to remove or secure all alcohol or prescription drugs in the home. Also, after being substance-free for a while, people are at a higher risk of overdose. This is mainly because one’s tolerance is not the same as before treatment. REMEMBER: What may have been a “normal” dose before treatment can be a deadly dose after treatment!

**If a loved one(s) used opioids, it would be helpful to keep Naloxone (or Narcan) in the house. This is necessary for safety because after treatment, there is a risk of relapse and overdose. Having Naloxone can save their life!

Studies suggest that most relapses happen in the first 6 months after treatment. One of the best ways to support recovery is to understand triggers that lead to substance use. Triggers are anything that makes a person think about using that usually leads to them craving the substance. Understanding their triggers and how to manage them makes this difficult period easier to manage. Also, finding people who are also in recovery to be friends with can help someone support their sobriety because it encourages them to remain drug-free, and it gives them support. They understand what each other is going through.

One way to increase the chances of maintaining a strong recovery is to have a good continuing care plan. Developing a continuing care plan is one of the last steps of treatment. Typically, a counselor or case manager will help them develop a plan to move out of the structured treatment environment and return to the real world. They can help them find other treatment providers, set up appointments, and provide information on local self-help meetings. Having a continuing care plan is important because it increases the chances of long-term recovery and reduces the chances of relapse. Like each treatment plan, each person’s continuing care plan will be different and unique to what they need. A counselor can help them decide what will be most beneficial for them after treatment.

Continuing care plans may include the following:

Counseling 

Working one-on-one with a therapist who understands addiction is not just physical dependence can help the person recognize triggers in their life and understand and address issues that could threaten their sobriety. Even just realizing where certain emotions are coming from and how to cope with stress can help someone stay on a good path in recovery.

Outpatient Programs 

Sober Dorms  

Sober dorms are for young adults ready to go to college. Some universities set aside dorms for students to live together.  Ask your university if they have dorms saved for college students in recovery.

Recovery High Schools 

Recovery high schools combine recovery and support into high schools that meet state requirements. In these high schools, teenagers can learn and get support from other teens in recovery.

Recovery Support Groups 

Support groups are a way for people in recovery to meet others in recovery, share their stories, and get support. Also, groups provide a community of people in recovery to connect with, so people can meet friends who are also in recovery. A person needs to find a group that works for them. Groups can be both 12-step and non-12-step. 12-step groups are common, and they involve someone admitting they are powerless over drugs and alcohol and looking to a higher power. Also, they take responsibility for broken relationships, harming others and try to repair these mistakes. Alternative support groups are all different. Someone can find groups with similar peers like moms or LGBTQIA+ recovery support groups.

Psychiatric Appointments

Having check-ups with mental health and medical professionals can help someone stay accountable after they have left treatment. Check-ups can happen as little as 4 times a year or as often as someone wants. In check-ups, a counselor will check a person’s mental health while a medical professional examines the person’s body to see if they have used substances recently.

 Sober Housing 

Sober houses are for people who have left residential treatment but want to stay in a monitored environment and live with others in recovery. These houses have a smaller number of residents and staff than a residential treatment program. They have very clear rules about staying sober. A typical stay is anywhere from 3 to 6 months. The main focus of the residents is on staying sober and moving to live outside of treatment.

Tips for Building a New Social Life

A person might find it hard to find new activities to do because so much of their life before treatment was centered around substance use.

Here are a few substance-free hobbies that someone can try:

• Go to the movies
• Take a class (like cooking)
• Volunteer
• Play a sport or games
• Learn to play an instrument

Opioids are commonly used for pain treatment and can include many of the medications below:

• Vicodin (hydrocodone)
• OxyContin (oxycodone)
• Dilaudid (hydromorphone)
• MS Contin (morphine)
• Fentanyl
• Percocet
• Methadone, etc.
• Heroin

If someone takes more opioids than their body can handle, they can pass out, stop breathing, and die.

Choose Before You Use!

If possible, do not use. There is no safe dose of opioids. But if you do use – Choose!

Go Slow – Not taking drugs for even a few days can drop your tolerance, making your “usual dose” an “overdose,” which can result in death. If you choose to use, cut your dose at least in half.

Wait – If you choose to use, wait long enough after you use to feel the effects before you even consider dosing again (regardless of IV, snorting, smoking).

Let Someone Know – Always let someone know you are using opioids so they can check on you- many who overdose do so when dosing alone.

Know What You Are Taking 

Go online to http://www.drugs.com/pill_identification.html to learn what pills you are taking, and the dose. Taking 5mg of Vicodin is different from taking 5mg of Percocet or 5mg of Methadone. The same amount of two different drugs may have different effects and symptoms. Know the difference between short-acting, long-acting, and extended release.

Avoid Mixing With Alcohol Or Other Drugs 

Drugs with the same effects (i.e., downers like opioids and alcohol) can dangerously slow breathing. For drugs with opposite effects (like opioids and stimulants), you may take too much of the downer because you cannot feel its full effects.

Know Your Tolerance 

If you have a period of not taking your prescribed opioid and then start taking it again TALK TO YOUR DOCTOR first! It may take less of the medication to have the same effect. Your tolerance may also be lower if you are sick, tired, have not eaten, or lost weight.

Avoid Using Other Than as Directed 

Prescription medications can take a long time to have their full effect. Keep this in mind if you think the medication is not working fast enough. Avoid chewing, cutting, crushing, or dissolving opioid tablets or capsules. Talk to your doctor if you need to take more medication than prescribed to get pain relief – you may need a different dose or type of medication.

Remember: Follow dosing and let your doctor know if you are in drug treatment or are taking any other medications!

Making the decision to stop using a drug once addiction has developed is not easy, and reaching sobriety is a huge accomplishment! However, like many other diseases, it is possible to relapse.

Relapse is seen as part of the recovery process because of how common it can be.

Here are some methods for avoiding relapse:

• Avoid friends who use drugs or alcohol and are not interested in getting sober.
• Avoid the places where you used to misuse your substance of choice- for example, bars, clubs, certain parks, or parts of your college campus.
• Consider going into a sober living home.
• Create a clear relapse-prevention plan and make yourself accountable to stick with it.
• Revisit your rehab facility here and there for a refresher.
• Attend regular therapy appointments.
• Take medications you need and check in with your psychiatrist regularly.
• Discuss your disease with your employer and build a safeguard around stressors at work.

 Relapse does not mean you are a failure or that your treatment did not work! It simply means that the symptoms of your disease have reappeared, and adjustments must be made in your treatment and recovery plan.  Each day of your life is a new step in the right direction. When you fall, you must learn to pick yourself up and continue your journey. Relapsing is not an excuse to use drugs; instead, it is a reason to resist substance use and continue your recovery with determination and pride.

So, you relapsed… Now what?

1. The first and most important thing to do is forgive yourself. Many people experience shame, guilt, and negative thoughts after relapsing. Just consider this part of the recovery process, forgive yourself, and move forward.
2. Identify what caused you to relapse. By exploring what led you to use again, you can try to avoid these situations moving forward.
3. Reconnect with your support network by being honest about your relapse and accepting their love and support.
4. Remind yourself that you can live a sober life, pick yourself up and continue on your journey!

Take care of work and family duties

It is important to let your job know about your treatment. Employers who care about you will be happy that you are getting the help you need.

Also, under the Family and Medical Leave Act, you are entitled to up to 12 weeks of medical leave, so your job is protected.

Also, ask family or friends to take care of your kids or pets while you are away.

Make sure you do not have any financial or legal loose ends

If you have bills that need paying while away, set up automatic payments or speak to someone you trust about paying them.

Also, if necessary, let the courts know you will be going to treatment if they do not know already.

Make sure you just bring what you need

Just bring things you really need to minimize outside distraction.

Also, most facilities will have rules for allowed items, so use it to pack what is allowed.

Enjoy time with your loved ones

Take time to enjoy time with loved ones before leaving. They can inspire you to make the most of treatment and reassure you of your decision to leave for treatment.

If they do not know already, tell them you are going through treatment, that you love them, and the changes you expect from going.

Write a letter or keep a journal

This is a good way to check in with yourself and see what is on your mind. You can write a list of goals or see how you feel about leaving for treatment.

Take time to relax

Take the time to do activities you like and relax to make yourself excited about this new chapter of your life. It’s perfectly normal to be nervous but try to be as calm as possible.