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The first step in most substance abuse treatment programs is detoxification (a process that helps the body to rid itself of alcohol and/or drugs). Patients undergoing detoxification are often treated with medications to help reduce the physical symptoms of substance withdrawal, which may include nausea, sweating, shakiness and extreme anxiety. However, not all patients receiving substance abuse treatment experience withdrawal symptoms, and the nature of symptoms depends on the substance that is being abused. In those that do experience symptoms, the severity varies. In severe cases, patients may experience hallucinations or convulsions during withdrawal. Sudden withdrawal from certain substances including alcohol and benzodiazepines can be life threatening.

Detoxification may occur in an inpatient program or in an outpatient program. Detoxification may take several days to a week or more. During this time, patients receive medical supervision and begin to receive information about the substance abuse problem.

After detoxification, substance abuse treatment may include the following:

• Counseling. Patients may receive individual or group counseling. Counseling usually begins with a focus on motivating a patient to stop using alcohol and/or drugs. It then shifts to a focus on helping patients to change behavior, repair damaged relationships or build new friendships with people who do not use alcohol or drugs. Family members may receive couples therapy, family therapy or other services to assist in the recovery process. Support from family members and others is a critical component of successful substance abuse treatment.
  
  
• Education. Patients may be instructed to read books or listen to tapes with information related to substance abuse and recovery. Written assignments may be required. Patients may also receive information about substance abuse issues, such as the impact of alcohol and drugs on the body and methods for managing a substance abuse problem.
  
  
• Training. This may involve life skills training, to learn a variety of skills, such as social skills, employment skills, anger management and money management. It may also include relapse prevention training, which teaches patients to identify and cope with circumstances that may trigger a relapse (using alcohol or drugs after a period of abstinence). These may include seeing a person with whom the patient once used alcohol and/or drugs or being in a place where the patient used alcohol and/or drugs.
  
  
• Alcohol or drug testing. Patients are sometimes required to take breathalyzer or urine tests to determine whether they have been using alcohol and/or drugs.
  
  
• Orientation to self-help groups. Patients are introduced to self-help groups, such as Alcoholics Anonymous and Narcotics Anonymous, which are designed to help people recover from substance abuse problems. People meet and share personal stories about recovery in an attempt to remain alcohol- and drug-free.
  
  
• Treatment for mental health disorders. Many people with substance abuse problems may also have other psychiatric disorders, such as depression or anxiety. Treatment may include counseling and/or medication such as antidepressants or anti-anxiety medications.
  

  

• Medication. Programs sometimes use medications to assist with substance abuse treatment. Medications do not cure addiction, but assist patients by helping them refrain from alcohol and/or drug use. Methadone, LAAM and buprenorphine are medications used to treat opioid addiction. They prevent withdrawal symptoms and allow patients to function normally. Naltrexone is a medication that reduces the craving for alcohol and disulfiram is a medication that causes a bad reaction when alcohol is ingested. Both of these help patients avoid drinking. The medication acamprosate helps to reduce the relapse rate in patients with alcoholism.