Substance abuse treatment relies on good brain function, which many users don’t have

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Methamphetamine and opioid use has become a problem in Australia, and a recent New South Wales parliamentary inquiry recommended urgent action for more substance treatment services, especially residential rehabilitation.

People seek drug and alcohol treatment because their substance use is having a negative effect on their health, wellbeing, relationships or other personal circumstances.

Excluding medications, the most effective types of treatment are counselling approaches such as cognitive behavioural therapy and motivational interviewing. But these methods won’t work for many of the people using these services, and that needs to be recognised before we can help them.

How does drug treatment work?

These methods are based around cognitive and behaviour change activities, where people analyse risky situations, thoughts and feelings by talking and thinking about how they can reduce or manage their substance use. Learning, problem-solving and planning for the future are key tasks.

Read more:
Explainer: what is cognitive behaviour therapy?

Most treatment guidelines suggest people try the lowest intensity treatment, such as weekly counselling, to start with. They will then seek more intensive options if they need more support to change their substance use.

Residential rehabilitation is the most intensive treatment. Residential programs are best for people who have serious substance problems they can’t control at all, or they also have mental health problems or unsafe home environments where drug use is common.

Residential rehabilitation offers a safe, structured environment with individual and group therapy for people to learn about controlling substance use triggers and cravings.

Not everybody progresses through treatment programs in the same way. People can stop turning up or get kicked out of residential programs, relapse, turn up again – sometimes seeking support for a different drug than the last time. Recognition of the range of problems substance users face requires us to look at what happens in treatment to work out how it works and for whom.

Many drug treatment pathways are based around cognitive and behaviour change activities.

Why doesn’t it work for so many?

Cognitive impairment is one issue where we need to change tack in order to help someone off drugs.

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