Treatment

The First Step…

According to Substance Abuse Mental Health Services Administration (SAMHSA), 1 in 4 will experience a Mental Illness in their lifetime. Substance abuse, drug addiction, and chemical dependency all mean the same thing: A mental illness.

1 in 4 mental illness
1 in 4 will experience a Mental Illness in their lifetime
HARD TRUTH: Treatment for substance abuse remains a very difficult subject to talk about because of “Stigma.”
addiction help

This stigma causes you to deny the evidence that your substance use has progressed from “Once in a while,” to something more serious. It also prevents you from seeking help or resisting help from others, and it keeps you in the cycle of use and regret.

You may have felt this shame and guilt because of the things you have done, the substances used to push away emotions caused by tragic circumstances in your life.

you know deep down there has to be something more than drugs and alcohol to make the feelings go away.

There is help, and you are almost there!

The first step is right in front of you. With treatment, people can and do recover, going on to lead healthier, happier lives.

The difficult first step on the path to recovery is admitting to yourself that your Alcohol or Drug use has become a problem and you need a source of strength greater than yourself to get your life back on track.

It's time to get honest with yourself

drugs and alcohol

Are you using legal or illegal drugs and alcohol as a way to help you deal with stress or anxiety in your life?

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Are you experiencing any social, legal and perhaps even health consequences because of your or a loved one’s use?

drugs and alcohol

Have you been dealing with strong urges and cravings to use despite thoughts of wanting to quit or slowing down?

person

Have you recently done things you may regret in order to get drunk or high?

If you answered Yes to any of these questions, then odds are it's time to Think SMART about treatment.

Find Help Here!

About This Page

Think SMART Oklahoma’s “Treatment” page aims to provide you with guidance to understanding the realm of treatment and the path of recovery.

While the information on this site is fairly comprehensive, it can never be complete; there is too much to discuss on an ever-evolving topic. We provide a few examples of treatment types, proven to be successful for treating people experiencing trauma, or Drug and Alcohol Addiction. We also provide some peer support and self help resources for you to explore.

Stages of Change in Treatment

It may take you a while to sort through the stigma of seeking help for your Alcohol or Drug Abuse. Clinicians refer to your readiness to accept your situation and move forward as Stages of Change. It’s time to be honest and ask yourself, “Which stage am I truly in right now?”

Precontemplation: “I don't see how my substance use should concern you or myself.”

Contemplation: “I can picture how quitting substance use would improve my situation.”

Preparation: “I am feeling good about setting a quit date, but I am wondering if I have the courage to actually do it.”

Action: “Staying clean for the past few weeks really makes me feel good, but this success makes a part of me want to celebrate… by getting loaded.”

Maintenance: “These recent months of abstinence have made me feel that I'm progressing toward recovery, but I’m still wondering whether full abstinence is really necessary.”

Depending on how honest you were with yourself, you may realize that you would benefit from talking to someone about your alcohol or drug use. A Mental Health Professional near you can help you discover the treatment path that will ultimately work best for you. With help, a life of choice is possible.

Find A Mental Health Professional

The Treatment Process

Your treatment journey will be different than someone else, but there will be similarities. For example, most people entering treatment experience a “screener” which helps determine the best path forward.

This section is not meant to be all inclusive. It reviews the most common processes that can be found in credible, evidence based treatment options.

Screening for Treatment

Screening, Brief Intervention and Referral to Treatment SBIRT

SBIRT is a public health approach to identify and provide early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital emergency rooms, trauma centers and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur.

  • Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.
  • Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
  • Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.

The Program, SBIRT Oregon, has made a quick video that demonstrates SBIRT in Action!

Treatment Planning

Once your screening is complete, you may receive a referral for a more in-depth assessment by a licensed Mental health professional. From there you may get results of the assessment, commonly referred to as a “Diagnosis” and then, if you wish to continue, you will be assigned a treatment team to develop a Treatment Plan.

If followed with honesty and consistency, your plan will lead to positive spiritual, mental and behavioral health outcomes.

It’s your right to ask questions about your treatment plan. Don’t be afraid to ask for more information from your treatment team. They are there to help you succeed.

Frequently Asked Questions

  • What is your treatment approach, preferred technique, or philosophy?
  • Do you involve family, groups, or use a 1 on 1 approach?
  • How do you know what I’m talking about or going through?
  • What is your experience working with people like me?
  • What are the expectations from me as a treatment patient?
  • When will my paperwork be finished so I can start treatment?
  • When can I see a healthcare provider about recommended meds? (MAT specific)
  • How do I deal with my triggers while I’m waiting for this process to take place?
  • How often do I need to come to the clinic/office?
  • How am I going to pay for this?

The Treatment Team

There will be many people with varied levels of knowledge, expertise and experience who will serve as your treatment team.They have different training, licenses or certifications to support your treatment path towards recovery.

Those listed here may not be exactly who is on your treatment team, but you will definitely have at least one or more.

Licensed to treat patients with mental health concerns and also “co-occuring” mental health and substance abuse disorders. Co-occurring means a patient has received a dual diagnosis and requires more intensive treatment to not only treat alcohol and drug addiction, but also a wide variety of mental health concerns, such as: depression, anxiety, schizophrenia, bi-polar disorder…etc. Many patients who present to treatment discover that their substance abuse began as an attempt to self-medicate to deal with underlying mental health concerns. This approach almost always results in further mental illness, social, legal and health consequences.

Licensed and fully capable to treat substance abuse disorders. These professionals often possess Master’s degrees and may be working toward the mental health component of their license, but do not currently possess a completed mental health certification. This means they are not licensed to treat dual diagnosed individuals.

Fully certified to treat substance use disorders like an LADC, they cannot treat clients with mental health diagnosis. The CADC process has changed a lot over the years, and now CADC’s are under guidance of an LADC. There are many CADC that are just as knowledgeable as LADC’s but they hold a bachelor’s degree while LADC’s mostly have achieved a Master’s degree.

Waivered Providers are medical doctors and nurses who prescribe MAT medications to people diagnosed with Opioid Use Disorder (OUD) or Alcohol Use Disorder (AUD).

Case managers, Family Care Managers and Care Coordinators assist patients with resources, starting and continuing services, addressing non-therapy related needs when they advise and connect patients with any resources not addressed by their assigned therapist or psychiatrist.

Licensed Clinical Social Workers (LCSW) advocate for people from every station in life, to ease them through transitions, hardships and mentally tough times, forming the link between people and caregivers in the health and psychology professions.

Social Workers assist people in finding the proper resources to get the care or supplement they need. Other clinical roles may include:

  • Observing client behavior, assessing needs and creating treatment strategies
  • Diagnosing psychological, behavioral and emotional disorders
  • Developing and putting treatment plans in place
  • Consulting with doctors, therapists and medical professionals
  • Administering social service programs
  • Instructing clients’ families during treatment

Psychologist vs. Psychiatrist

Through the media, you have probably heard of these next two professionals, but may not know the difference between them or how they fit into the big picture of Substance Abuse or Mental Health Treatment. Psychologists are able to provide all services that a therapist can provide, but can also conduct numerous tests to better help treat and diagnose. Psychiatrists are able to meet with patients to address needs not met through therapy alone (medication or otherwise).

Additionally, each have their own focus and specialties:

Specialties

Psychologist

Clinical (pediatric, child, health), Counseling, Community, School, and Forensic. Trained to provide assessments, diagnosis, conduct and publish research. Teach at Universities, conduct evaluations and provide guidance on treatment models and programming. In some states Psychologists can receive credentials to also prescribe Mental Health medications known as psychopharmaceuticals. For example, testing for Autism Spectrum Disorder, IQ, other organic brain issues…etc.

Psychiatrist

Provides Public health, Child, Geriatric, Substance abuse, and Forensic Medication Evaluations.

Qualifications

Psychologist

A doctorate (PhD. Or PsyD) level clinical professional vs. a Master’s level LADC/ Bachelor’s level CADC, 4-6 years of classwork, 3+ years of clinical practicum and one-year of internship/residency, fellowship (not required)

Psychiatrist

M.D. Completed Medical School as they are officially Doctors who have specialized in psychiatry vs dentistry or cardiology. Four plus years of classwork, 2-4 years clinical, residency and fellowship.

Areas of Focus

Psychologist

Assessment (Cognitive (intelligence, development, etc.), ADHD, ASD, learning disabilities, etc.), Diagnosis, Evidence-Based Treatment, Consultation, Research and Teaching.

Psychiatrist

Diagnosis, Psychopharmacology*, Consultation, Research and Teaching

*Psychopharmacology is the science/study of the effects of medication on the mind. This medication is often prescribed by a psychiatrist, but can also be prescribed by a general practitioner. Psychologists and therapists do not prescribe medication. Currently, Cherokee Nation Behavioral Health employs three different psychiatrists for this service, and has utilized general practitioners and nurse practitioners in the past, as well.


Common Treatments

No matter which type of provider delivers treatment services to you, they will be following an evidence based method to ensure the services are relevant to your needs and effective at treating people with similar diagnoses.

Here are some of the ore common types used in treatment of Substance Use Disorders:

CBT is a structured, action-oriented type of psychological treatment that was created in the 1960s by Dr. Aaron Beck, founder of the Beck Institute for Cognitive Behavior Therapy. In recent years, a growing number of clinicians are adopting this technique to teach people to identify and then “reset” their negative patterns of thoughts and reactions.

Who might benefit from CBT?

The American Psychological Association’s website says that CBT can be effective in addressing a range of disorders, including depression, anxiety disorders, alcohol or drug abuse, relationship issues, and other serious forms of mental illness. Often CBT is used in conjunction with other behavioral health approaches; the treatment protocol is personalized for an individual’s specific diagnosis and needs.

Somatic Experiencing therapy (SE) is a body focused trauma therapy created by Dr. Peter Levine.

Many of the trauma based therapies struggle to connect the mind to the body to re-negotiate trauma memories. The body and mind are inevitably connected. Somatic Experiencing is an approach to treating individuals affected by trauma. It is a very gentle and powerful therapeutic intervention for persons of all ages affected by trauma. SE is also a very helpful intervention for individuals suffering from chronic pain and chronic health conditions.

Who Might Benefit from SE?

Anyone who has tried other forms of talk therapy without relief from their trauma symptoms or chronic pain syndromes may benefit from Somatic Experiencing therapy. Somatic Experiencing therapy is not a cognitive therapy or talk therapy approach; it works from the body to address nervous system dysregulation caused by trauma to the mind and body. It is known that nervous system dysregulation is a main culprit behind many chronic health conditions. The main goal of Somatic Experiencing therapy is to help the individual recognize and release unhealthy holding patterns in their body that contribute to chronic conditions and create a new feedback loop to the brain that the trauma they experienced to their mind and body is no longer happening to them; it's in the past. This process helps the nervous system become more healthy and regulated thereby reducing chronic health symptoms and mental health trauma symptoms (such as insomnia, anxiety, depression, and hypervigilance).

The Matrix Model is a comprehensive, multi-format program that covers six key clinical areas:

  • Individual/Conjoint Therapy
  • Early Recovery
  • Relapse Prevention
  • Family Education
  • Social Support
  • Urine Testing

Who Might Benefit from MMT?

MMT is commonly used to treat Substance Addictions. MMT combines cognitive, behavioral, and motivational enhancement, for individuals, couples and families. There is also support for Twelve Step facilitation and Social Group therapy.

Matrix Model Guide for Clients Matrix Model Guide for Counselors

These guides may claim to be for treating specific substances, however most of the methods work well for anyone and any type of substance abuse.


Medication Assisted Treatment (MAT)

Our intents and purposes for mentioning MAT revolves around treating Opioid Use Disorder (OUD). Regardless, if you took opioids for the feeling they cause, or under the direction and care of a licensed medical provider, extended opioid use can alter the fragile chemistry and function of the brain’s pleasure and reward center, resulting in a mental illness known as Opioid Use Disorder.

Medication Assisted Treatment, Medication Assisted Therapy, Medication Assisted Recovery, Medications for Addiction Treatment and others, are various terms to explain the same concept, which is a combination of behavioral health therapy and medication to treat people with OUD.

MAT medications stabilize the craving and withdrawal cycles users experience when they cannot find a high enough dose of opioids to prevent them; when withdrawal and craving is prevented, users in treatment can begin to make steps toward recovery.

*Combining medications used in MAT with anxiety treatment medications can be fatal. Types of anxiety treatment medications include derivatives of Benzodiazepine, such as Xanax or valium.* Source: SAMHSA

Who Might Benefit from MAT?

The ultimate goal of MAT is full recovery, including the ability to live a self-directed life. This treatment approach has been shown to help anyone who:

  • Is tired of living with the cycle of craving and withdrawal from Prescription Opioids or Heroin.
  • Has received a diagnosis of Opioid Use Disorder.
  • Is ready to address the underlying causes of addictive behaviors related to opioid abuse.
  • Wants to improve birth outcomes for women who have substance use disorders and are pregnant.
  • Wants to increase the ability to gain and maintain employment, while decreasing illegal opioid use and other criminal activity.

There are three medications commonly used to treat opioid addiction:

Clinic-based opioid agonist that does not block other narcotics while preventing withdrawal while taking it; daily liquid dispensed only in specialty regulated clinics.

More Information

Office-based non-addictive opioid antagonist that blocks the effects of other narcotics; daily pill or monthly injection.

More Information

Office-based opioid agonist/ antagonist that blocks other narcotics while reducing withdrawal risk; daily dissolving tablet, cheek film, or 6-month implant under the skin. Risk for both overdose and withdrawal is low with buprenorphine, and it has the most evidence for long-term effectiveness in preventing opioid overdose among people with an opioid use disorder.

More Information

Check with a treatment provider to determine which one is right for you.

MAT Frequently Asked Questions

For most people who receive MAT, the medication weakens or stops cravings and withdrawal symptoms, and blocks the effects of other opioids. Research supports the use of MAT to treat an opioid use problem, as well as reduce the need for people with opioid use disorder to undergo inpatient detoxification when using the MAT buprenorphine.11,12,13,16

In communities where MAT is available and accessed, it decreases opioid-related overdose deaths, criminal activity associated with obtaining opioids, and lowers infectious disease transmission.14

Opioid Treatment Programs (OTPs) incorporate the use of MAT to treat participants with opioid use disorders because it is individually-tailored for each participant, providing a more holistic approach to medication and behavioral therapy.11 According to federal law, OTP participants are required to receive medical, counseling, vocational, and other assessment and treatment services. This additional support contributes to the person’s treatment and recovery journey; indeed, the research shows MAT increases social functioning and likelihood the patient will remain in therapy.11,14

Three medications are currently approved by the Federal Drug Administration to treat opioid use disorder: buprenorphine, methadone, and naltrexone. Buprenorphine is taken orally (either as a tablet or film), usually on a daily basis and can be prescribed by certified doctors for to allow the patient to take at home. Risk for both overdose and withdrawal is lower with buprenorphine than the other types of medications. Methadone is also taken orally, but in liquid form. It requires more oversight in its administration, often dispensed in daily dosages at addiction treatment clinics and OTPs. Methadone is the most effective MAT for people with extensive drug use histories.16

Both buprenorphine and methadone are partial opioid agonists, which means they bind to the same opioid receptors as opioid agonists (e.g. heroin, morphine, oxycodone), but produce a severely weakened opioid effect. When a person is used to using opioids, their body can become physically dependent on them in order to perform even basic functions. Hence removing all opioids from the can cause the person to begin severe withdrawal symptoms.15 To help the person’s body gradually adjust to having smaller and smaller doses of opioids, MAT often use medications containing partial opioid agonists, like buprenorphine and methadone. Among MATs, buprenorphine and methadone have the most evidence for long-term effectiveness in preventing opioid overdose among people with an opioid use disorder.13

Naltrexone is administered as a monthly injection. It is an opioid antagonist, so while it binds to the same opioid receptors as buprenorphine and methadone, it will not produce any opioid effect. It will not satisfy any physical dependence on opioids, which means that a detoxification period of seven to ten day is first required by the patient before beginning naltrexone. Otherwise, the person will experience withdrawal symptoms. This also means that if the person takes other opioids while on naltrexone, they will not be able to feel the opioid effects (e.g. euphoria, analgesia). This elevates their risk for overdose. Risk for overdose also increases when a person takes naltrexone for a period of time, then returns to using opioids because that person’s opioid tolerance will be much lower than it was before starting naltrexone. Research shows naltrexone can help people remain in treatment longer and recover from opioid use disorder.16

The minimal amount of time someone should receive methadone treatment is twelve months, but the medical needs of each individual are different. Many individuals stay on the medication for much longer.15

When people quit taking opioids suddenly, they will experience symptoms of withdrawal such as pain, diarrhea, nausea, and vomiting. They will also experience strong cravings to use opioids. Both the physical withdrawal symptoms and the strong psychological cravings make it difficult to quit using these drugs without medication assistance.14,15

If you are a provider, click here to learn about obtaining your DEA waiver to prescribe MAT medications.

To learn more about MAT, please visit SAMHSA.gov website.


Treatment Near You

When it comes to treatement, one side DOES NOT fit all!

To find a treatment provider near you please visit SAMHSA’s Online Treatment Provider Locator. There you can enter your zipcode or City and State, and choose a variety of search filters to pinpoint your exact needs.

As a reminder, Buprenorphine refers to MAT medication for treating opioid addiction.

Treatment Centers

When it comes to treatment centers, there are important distinctions based on the intensity of your treatment needs.

Involves scheduling treatment around work or school during the day or evening and does not include overnight stays. Outpatient focuses on relapse prevention and behavioral health strategies.

Also known as Residential, this type Involves getting away from your spheres of influence and addiction triggers to undergo intensive treatment at a 24/7 facility where you will live until your treatment program is finished. Can last from a few days to several months.

For people who require ongoing medical monitoring but wish to still live at home and have a stable living environment. These treatment programs usually meet at a treatment center for 7 to 8 hours during the day, then you return home at night.


References

11: Substance Abuse and Mental Health Services Administration (SAMHSA). (2015, September 28). Medication and counseling treatment. Link

12: Volkow, N. D., Frieden, T. R., Hyde, P. S., Cha, S. S. (2014). Medication-assisted therapies–Tackling the opioid-overdose epidemic. New England Journal of Medicine, 370(22), 2063-2066.

13: United Nations Office on Drugs and Crime & World Health Organization (UNODC/WHO). (2013, June). Opioid overdose: Preventing and reducing overdose mortality. Vienna, Austria: United Nations. Link

14: National Institute on Drug Abuse. (2016, November). Effective treatments for opioid addiction. Link.

15: National Institute of Drug Abuse (2018). Advancing addiction science: What are the treatments for heroin addiction? Link.

16: SAMHSA. (2016). Decisions in recovery: Treatment for opioid use disorder [Electronic decision Support Tool]. Link.

html> Think SMART Oklahoma: An in-depth look at Oklahoma's opioid epidemic

SAFE SOLUTIONS

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Source: DrugAbuse.gov

The Data

We have seen promising progress toward the reduction of opioid prescriptions per 100 Oklahomans since we launched the Safe Solutions campaign.

The latest available data shows that in 2018, for every 100 Oklahomans, providers wrote 79.1 opioid prescriptions as compared to the U.S. average rate of 51.4 prescriptions.

In 2017, Oklahoma providers wrote 88.1 prescriptions per 100 persons, which itself is a 30% decline since 2012 when the rate was 127 opioid prescriptions per 100 persons.

Also In 2018, there were 308 opioid overdose deaths and over 255 million opioid pain pills dispensed to Oklahomans. A reduction of around 71 millions pills since 2015.

This is great progress, but with so many opioid pain pills still in Oklahoma homes, there remains a high risk for Diversion. TSO understand that it may be convenient to store prescribed pain or anxiety medications for easy access, but that can make it simple for others to find them, turning you into an accidental drug dealer.

Why take that risk when Safe Solutions are available?!?


Safe Home Storage

Safely storing medication is an easy and effective way to prevent others from taking your medication. There are many types and sizes of medication lockboxes available with varying security features out there. TSO has tried many of them and is currently providing Safes from a variety of quality manufacturers.

* Only eligible to residencies within the 14 county Cherokee Nation Reservation*


Safe Home Disposal

Products like Deterra Pouches by Verde Technologies make the active ingredients in medications inactive, so there is no potential for abuse if found in the trash. If you have prescription opioids in your home, Think SMART.

* Only eligible to residencies within the 14 county Cherokee Nation Reservation*


Take-Back Programs

Not all law enforcement agencies or pharmacies are able to fund a take-back program, but numerous communities across Oklahoma have them and periodically take advantage of prescription drug take-back events.

Northeast Oklahoma residents are encouraged to clean out their medicine cabinets and deliver their expired, leftover, or unwanted pills to a take-back event where they can be assured of SMART disposal.

Many communities also offer 24-hour permanent medication drop box locations. These are free and anonymous.

If you live within the Community Action Network, find a drop box location near you!


Myths & Facts

toilet with pills

MYTH: Flushing Medications

It’s okay to flush my medicines in the toilet or pour them down the drain, because the FDA encourages it for dangerous medications and it is not harmful to the environment.

FACT

Leftover medicines that are flushed or poured down the drain can end up polluting Oklahoma’s water, impacting aquatic species and contaminating our soil, which then affects our food and water supplies. Because disposed medicines create a chemical solution in the waste water that can be next to impossible to filter out, Oklahoma’s rich water resources become laced with chemicals that can lead to dangerous health conditions in young children and adults. Using a medicine take-back program is a simple, sensible way to reduce the amount of medicines entering the environment.

sweeping pills

MYTH: Trash Disposal

Mixing medicines with coffee grounds or kitty litter before throwing them in the trash will prevent drug theft.

FACT

Throwing medicines in the trash is not the SMARTest method – especially for controlled substances like hydrocodone, oxycodone or other narcotics, and sedatives. These prescription drugs can be found and taken by other people, even if they are mixed with things to make them unappealing. The FDA, DEA, and EPA, recommend using medicine take-back programs as the best way to dispose of your unwanted medicines. These agencies advise trash disposal ONLY as a “last resort” option until all our communities have convenient take-back programs.

“Unused prescription drugs thrown in the trash can be retrieved and abused or illegally sold…Take-back programs are the best way to dispose of old drugs.“

Source: DEA, April 30, 2011

toilet with pills

MYTH: Manual Destruction

It’s okay to crush medicines before throwing in the trash so curious children don’t mistake them for candy.

FACT

Crushing pills to disguise them before disposal is challenging and hazardous and puts the handler at risk of exposure to the drug through skin contact or inhalation of dust particles. Many medications are intended to be released in the body over time, and crushing pills can release a dangerously high dose. Also, throwing unwanted medicines in the household trash does not ensure that curious kids cannot find them; there’s an epidemic of unintentional poisonings from medicines in our homes, and children are the most common victims. Also, pets and animals are not discouraged by kitty litter or other substances when getting into the trash. Human medications are the leading cause of pet poisonings, most often from trash-related toxic exposures.


Frequently Asked Questions

Some communities in Oklahoma may not have access to a drug take-back program. If you do not have a take-back location within reasonable driving distance, please follow these last resort instructions.

For all other Prescription Drugs:
  1. Do not flush medicines down the toilet or drain.
  2. Keep the medication in its original container.
  3. To discourage consumption, add something very unappealing, such as used kitty litter or coffee grounds or rotten food. Do not crush the pills.
  4. Tape the container lid shut with tape, place in a sealable bag, and then place in a non-transparent container to ensure that the contents cannot be seen.
  5. Discard the container in the trash. Do not place in the recycling bin. Make sure your trash cannot be accessed by children, pets, or others who might be looking in the garbage for drugs or food. And please remember that trash disposal does not adequately protect people and our environment from exposure to potentially dangerous drugs.

The collected medicines are disposed by high temperature incineration at a secure permitted facility. This is the most environmentally sound disposal method which ensures the chemicals are completely destroyed.

Used needles, injectors, EpiPens, lancets, or other objects capable of puncturing skin may be capable of transmitting disease. Some cities have special regulations for transportation and disposal of these “biohazardous” or “biomedical” wastes.

For safe disposal of needles and syringes, ask your pharmacist, contact your local health department or your local waste collection and management agency.

For chemotherapy drugs and certain liquid controlled medications, contact your prescribing medical office to see if they will accept the drugs for proper disposal.