According to a report released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2023, data obtained in 2021 showed that 16.5% of people ages 12 and over living in the United States met the criteria for a substance abuse disorder. This included 29.5 million people with an alcohol use disorder and 24 million with a drug use disorder. Of these people, 94% had not received any treatment. But what does it mean to receive treatment for a substance abuse disorder and where can someone find treatment? 

In my last column, I explained the various mental health professionals: psychiatrists, nurse practitioners, physicians’ assistants, licensed professional counselors, licensed independent social workers and licensed marriage and family counselors. Anyone in these professions may decide to specialize in treating substance abuse. If they do decide to specialize in alcohol and drug addiction, they should seek appropriate training and supervision. South Carolina also has a licensed addictions counselor, which is a professional who has a master’s degree in counseling or social work, who has focused their internship on substance abuse, and passed one of two national exams for substance abuse counselors. 

Like many states, South Carolina also allows individuals with a bachelor’s degree to receive certification allowing them to work as addictions professionals. Through the Addiction Professionals of South Carolina (APSC), there are two levels of certification at the bachelor’s degree level: Alcohol and Drug Counselor (ADC) and Advanced Alcohol and Drug Counselor (AADC). To obtain an ADC or AADC, requires 300-450 hours of education in addictions treatment plus 4,000-8,000 hours working directly in addictions treatment while receiving supervision from a qualified supervisor. Clinical supervisors must have a master’s degree and 10,000 hours working in alcohol and drug treatment settings (4,000 of those hours must be as a supervisor). Clearly, a lot of study and work goes into earning these certifications. The APSC also offers certification programs to become a peer specialist which can be earned by those with a high school diploma or GED. 

When we think of treatment settings for alcohol or drug abuse, we often think of either inpatient treatment or peer led 12-step groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). In addition to these settings, help can be found through individual counseling, non-12-step groups and partial or intensive outpatient programs. Partial or intensive outpatient programs (also available for mental health issues) involve going to a structured treatment program, much like an inpatient program, without having to spend the night. Many of these treatment options are available through telehealth, which can make them easier to access. 

Treatment for substance abuse generally includes a period of detoxification in which the individual is monitored while they are in the early days of not using drugs or alcohol. The type of substance used, and the severity of the addiction, will determine if the detox can be done at home or requires hospitalization. During detox, medications may be administered to help with withdrawal symptoms which can be life-threatening as well as extremely uncomfortable. While detox can be seen as the official beginning of sobriety, it is not uncommon for an individual to have gone through a period of counseling and/or self-reflection to build motivation for living without using their substance(s) of choice. After becoming sober, it is important for the individual to seek treatment and support from treatment professionals and sober peers, family and friends because sobriety is much more than not using. 

As family and friends who do not have an addiction, it is easy to think life will be better if the loved one just stops using; however, it is important to remember that stopping substance use involves making many changes which the individual may or may not feel ready to make. Sobriety means cutting off the brain from a substance it is addicted to. It also means the person must learn how to cope in a healthy way with situations and feelings alcohol or drugs were used for. Often, one of the more painful aspects of becoming sober is facing the harm done to relationships. Because of these factors, substance abuse treatment needs to include: 1) awareness of why the substance was used and how it has impacted the person’s life, 2) identifying triggers and learning refusal skills, 3) teaching and practicing coping skills such as how to tolerate discomfort without a substance, and 4) interpersonal and communication skills for repairing relationships. 

Remember, if you or someone you know is in crisis, you can dial 9-8-8 to reach a crisis counselor who will listen and identify how to best help.