It’s maddening for family members and loved ones of those substance-addicted individuals who seemingly just ‘refuse to change’. Sometimes, a stint in drug rehab sets them on a positive trajectory, only to have it all come crashing down after yet another relapse.

But, are they really making a choice? This confounds many, but the answer is ‘no’, if you adhere to the disease model of addiction, which is almost universally accepted by the medical and behavioural health community.  The disease model of addiction tells us that having a substance use disorder (SUD) is a treatable mental disorder that carries with it the risk of relapse, just as any disease does.  Relapse rates for opioid addiction are similar to diabetes and hypertension, but sufferers of these other progressive medical conditions don’t consider the treatment (or the patient) a failure when a setback occurs.

An SUD is a chronic disease of the brain. It is characterized by compulsive and uncontrollable drug cravings. Those who have become physically and psychologically addicted will continue to use and seek out drugs, despite the adverse consequences in their lives because prolonged drug abuse creates lasting changes in the brain, re-wiring how it works. 

Without drugs, an addicted person will feel sick, anxious, and irritable. The withdrawal symptoms can be so severe that it becomes dangerous. To alleviate those effects, the person must use drugs again, thus beginning the vicious cycle of addiction.

According to the National Institute on Drug Abuse (NIDA): ‘Drug addiction is when you can’t stop taking the drug even if you want to. The urge is too strong to control, even if you know the drug is causing harm. Addiction can become more important than the need to eat or sleep. The urge to get and use the drug can fill every moment of your life. Addiction replaces all the things you used to enjoy. A person who is addicted might do almost anything: lie, steal, or hurt people – to keep taking the drug.’

Studies into brain imaging have proven that addiction causes visible, physical changes in the brain. Specifically, it affects the areas that are critical to judgement, decision-making, learning and memory, and behavioural control. This provides tangible evidence that addicted individuals do not have control over their drug use or the easy ability to stop, even if they want to. Their body, their brain, and their cravings too often take over. 

This is also a common reason why people relapse. The changes that drugs cause in the brain are long-lasting. They do not go away overnight and take significant time to heal. Those who only attend treatment for a short period of time, and do not fully learn how to avoid or cope with their triggers, will have difficulty overcoming drug addiction for good. 

So what does my loved one do?

Enough of the bad news, and time for something positive: there has never been a better time to seek treatment for an SUD than right now.  We have more tools at our disposal than ever before, and this includes recent advancements in medication-assisted treatment (MAT).  

MAT is the use of medications (like Suboxone) that reduce cravings and withdrawals in early sobriety.  When combined with other evidence-based practices, like therapy and support groups, recovery rates can be as high as 80%, according to the American Society of Addiction Medicine (ASAM). MAT allows for addiction treatment providers to quickly treat the ‘whole patient’, and return them to a state of ‘wellness’ much sooner than in the days before MAT.

Getting help from SAMHSA and what to look for

If you or someone you love is struggling with substance abuse, plenty of resources are available, but not all treatment programs and methods are created equal. Knowing which programs and resources are backed by science and data is vital to ensuring you get the best help possible for you or your loved one. This is why we recommend seeking out comprehensive programs that use an array of evidence-based practices.

To see what resources are available in your area, contact SAMHSA’s confidential, 24/7 National Helpline at 1-800-662-4357. 

If you or your loved one are in California, you can also contact Confidential Recovery at 1-619-452-1200.

Scott H. Silverman is one of the nation’s leading experts on addiction and recovery.  He’s made countless public speaking engagements and appearances on television to raise the alarm about the opioid epidemic. He is the founder and CEO of Confidential Recovery, an outpatient drug rehab program in San Diego that specializes in helping Veterans, first responders, and executives achieve long-term recovery.