1. Treatment and Rehabilitation of
Drug Addiction
S. Parasuraman M.Pharm., Ph.D.,
Senior Lecturer, Faculty of Pharmacy,
AIMST University,
Bedong 08100, Malaysia.

2. Drug rehabilitation
• Drug rehabilitation (drug rehab) is the medical and
psychotherapeutic treatment used to enable a patient to cease
substance abuse and become a normal and productive member of
society.
• Drug rehabilitation addresses the physical and psychological
aspects of drug dependency.
– Eliminating the physical dependency may involve the use of
chemical antagonists that block the action of the addictive
drugs. E.g.: methadone for withdrawal symptoms of heroin,
disulfiram for alcohol addiction.
– The psychological dependency on drugs is harder to treat
because it involves learning new patterns of behavior. Drug
rehabilitation programs attempt to teach the patient new
methods of interacting in a drug-free environment.

3. Drug rehabilitation
• Rehabilitation programs need to work closely with the patient.
• The most successful programs offer a variety of options including
– residential inpatient treatment
– short-stay options
– outpatient treatment with local support groups
– extended care centers
– sober houses
– addiction counselling
• Inpatient treatment is best accomplished when physicians and
nurses are available around the clock to ensure a safe withdrawal
from alcohol and other drugs.
• Rehabilitation is probably the hardest thing that an addict will have
to accomplish. It is not unusual for an individual to relapse or fall off
the wagon and resume drug or alcohol abuse.

4. Drug rehabilitation
• Detoxification alone is ineffective.
• The National Inst. on Drug Abuse (NIDA) recommends
detoxification followed by both medication and behavioral
therapy followed by relapse prevention.
• Purpose of Drug rehabilitation:
• Drug rehabilitation program if proved to be successful, that
will avoid many legal, psychological, financial, physical and
social consequences caused particularly by extreme drug
abuse.

5. Types of behavioral therapy
• Detoxification
• Group therapy:
– Cognitive-behavioral therapy
– Multidimensional family therapy
• Motivational interviewing
• Motivational incentives
• Miscellaneous: Lectures, Written Work, Holistic activities

6. Detoxification
• Every patient is required to follow the rules within the
recovery program to avoid any chances of relapse.
• The residential drug addiction treatment programs generally
offer varied therapeutic sessions that assist individuals in
enhancing their health.

7. Detoxification
• A safe detoxification process is initiated, overseen by a medical
doctor and nursing team. Once this has been successfully achieved
the patient is ready to start their program of recovery.
• There are several types of detoxification processes carried out
which offer help from drug addiction. These include:
– inpatient treatment
– out-patient treatment
– extended care and local support groups
– addiction counselling
– medical care
– Some rehab centers may also offer gender and age specific programs.
• Detoxification required minimum 30 days hospital administration.
During the stay, the patient will be offered round the clock medical
care and a comprehensive schedule consisting of counseling,
therapy, and recreational activities.

8. Group Therapy
• Starting with counseling and detoxification, the treatment
progresses through numerous stages such as, group therapy
and family therapy.
• The idea of group therapy is to share examples of addiction
related consequences.
• Sharing the feelings related to past and present such as guilt
and shame can help the affected person with acceptance and
recovery.
• In a group therapy session, an addict is able to contribute and
listen to stories and other insights toward the reasons for drug
addiction, and how to avoid triggers, and how to successfully
live a sober life.
• Duration of the therapy: weeks to month

9. Group Therapy
• Mode of the treatment: personal approach. Once individual
therapy is successfully completed, it will leave the addict in a
position to direct their life on a healthy path.
• Objective of the individual and group therapy sessions is the
creation of a support network to leave healthy life.
• Many of the facilities offer intensive therapy, which in some
cases is needed if the addict suffers from suicide tendancies,
depression, or other psychological issues.
• Daily responsibilities and activities are given to each addict,
which creates a sense of independence.
• This may be the first time in the addict’s life that he or she has
had responsibilities.
• Family members also require learning how to behave and
interact with the addict particularly if the addiction has
sustained for several years.

10. Group Therapy
– Cognitive-behavioral therapy, which seeks to help
patients to recognize, avoid and cope with situations in
which they are most likely to relapse.
– Multidimensional family therapy, which is designed to
support recovery of the patient by improving family
functioning.

11. • Motivational interviewing, which is designed to increase
patient motivation to change behavior and enter treatment.
• Motivational incentives, which uses positive reinforcement to
encourage abstinence from the addictive substance.
• Lectures: These lectures are delivered by qualified and well
trained people and these are focused upon addiction and
related issues regarding dysfunctional behaviors which are
helpful for the addict’s recovery.
• Written Work: This may include writing about ones life, their
addiction history and formally going through various steps of
treatment Process involved in rehabilitation.
• Holistic activities: exercise, massage, meditation and yoga are
often part of the recovery program.

12. Rehabilitation for alcohol addiction
• There are many different options for treatment.
• There are both inpatient and outpatient centers, and each alcohol
rehab facility has their own programs designed for treatment.
• One of the most crucial steps in attending an alcohol rehab center is
the detoxification process.
• During this stage, many people are learning to live without alcohol
for the first time in a long time.
• Detoxication can be dangerous, and an alcoholic’s body can go into
shock when they are flushing the toxins out of their body.
• Rehab professionals are trained to treat individuals as they go
through the process of detoxication and withdrawal, and their
expertise can make the difference between life and death.

13. Rehabilitation for alcohol addiction
• In certain cases of extreme alcoholism, a person can go through
delirium, which can include symptoms so severe as seizure or even
cardiac arrest.
• Without the proper treatment, detoxication can be fatal.
• By using the proper medications, these withdrawal symptoms can be
treated and help alcoholics get through this process more easily.
• A patient who shows up an alcohol-withdrawal syndrome should be
considered to be in lethal condition and attention given to hydration
and electrolytes, vitamins, especially high-dose thiamine
administered.

14. Rehabilitation for alcohol addiction
• Sometime the sedating medication that is given for suppressing
withdrawal may elicit cross-tolerance with alcohol.
• To avoid cross tolerance, select a short-acting benzodiazepine such as
oxazepam at a dose of 15-30 mg every 6-8 hours according to the stage
and severity of withdrawal.
• Anticonvulsants such as carbamazepine have been shown to be
effective in alcohol withdrawal.
• After medical evaluation, uncomplicated alcohol withdrawal can be
treated effectively on an outpatient basis.
• When there are medical problems, a history of seizures, or
simultaneous dependence on other drugs, hospitalization is required.

15. Rehabilitation for alcohol addiction
Drugs for alcohol addiction:
• Disulfiram, Naltrexone, Acamprosate
• Disulfiram blocks aldehyde dehydrogenase and metabolism of ethanol,
which results accumulation of acetaldehyde. Accumulation of acetaldehyde
produces an unpleasant flushing reaction when alcohol is ingested.
• Naltrexone (adjunct therapy) an opioid receptor antagonist that blocks the
reinforcing properties of alcohol. Chronic administration of naltrexone
resulted in a decreased rate of relapse to alcohol drinking.
• Acamprosate (attenuate one of the mechanisms that lead to relapse) is a
competitive inhibitor of the N-methyl-D-aspartate (NMDA) type glutamate
receptor.

16. Rehabilitation for heroin addiction
Detoxification
• Thus the primary objective of detoxification is to relieve
withdrawal symptoms while patients adjust to a drug-free
state.
• The first phase in the treatment of heroin addiction is to
minimize the severity of withdrawal symptoms and other
medical complications.
• This is done with several synthetic drugs that duplicate heroin
in the body but can be given in tapered doses until the
addicted person can eventually be drug free.

17. Rehabilitation for heroin addiction
• Buprenorphine
• Buprenorphine is the newest medication for treating opiate
addiction. It binds to the same receptors as
morphine/heroin but does not produce the same effects.
• It is much safer than other detoxification medications and in
some combinations will block the euphoria of other opiates
after ingestion.
• Buprenorphine, along with other medications, is an effective
detoxification medication in that it produces a lower level of
dependence thus making the transition to drug-free status.
• less uncomfortable.

18. • Methadone treatment has been used for more than 30 years to effectively
to treat opioid addiction.
• Methadone used for heroin withdrawal treatment
• Opioid acts – 4to 6 hr
• Methadone acts – 24-36 hr
• Methadone has ability to eliminate cravings
• Its also act μ (mu) and NMDA receptor
• Used for treatment of heroin withdrawal
• Heroin withdrawal can be treated by
– Methadone maintenance therapy (MMT)
– Buprenorphine therapy
– Buprenorphine + naloxone therapy
– Behavioral therapy
• Other agents: Clonidine
Rehabilitation for heroin addiction
Methadone therapy for Heroin Addiction

19. Rehabilitation for heroin addiction
• A third method of treating opioid withdrawal involves
activation of the endogenous opioid system without
medication.

20. Rehabilitation for cocaine addiction
• Full-blown paranoid psychosis
• Cocaine addiction may lead to increasing
irritability, restlessness, and paranoia. This can often result in
full-blown paranoid psychosis, in which the user loses touch
with reality and experiences auditory hallucinations.
• Disturbances in heart rhythms
• Injecting cocaine can cause severe allergic
reactions, disturbances in heart rhythms, chest
pain, strokes, seizures, headaches, and instant heart attacks.

21. Rehabilitation for cocaine addiction
• Treatment:
– No medicine showed efficacy against cocaine addiction.
– Animal models suggest that enhancing GABAergic inhibition can
reduce reinstatement of cocaine self-administration, and a controlled
clinical trial of topiramate (TOPAMAX) showed a significant reduction
in cocaine use.
– A different approach was taken using modafinil, a medication that
increases alertness and is approved for the treatment of narcolepsy.
– Behavioral therapy

22. Thank you