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What Is Addiction?

Addiction Is a Pervasive but Surprisingly Misunderstood Disease

For a behavioral health condition that affects millions of Americans, their families and communities, addiction to alcohol or other drugs is widely misunderstood and stigmatized. Simply put, addiction is a disease. The behavioral aspects of the disease are characterized by the continued use of alcohol or other drugs even when that use causes harm or interferes with achieving goals in life.

You might also hear addiction described as “a disease of the mind, body and spirit.” That’s because the condition involves a physical and psychological craving or compulsion to use mood-altering substances, and because recovery from addiction involves physical, psychological and emotional healing.

Behavioral Signs and Symptoms

  • Always uses substance to intoxication
  • Uses substance at inappropriate times such as before driving, at work, or at school
  • Misses work or school
  • Damages relationships
  • Poor performance at school or work
  • Steals or borrows money from work, home, or friends
  • Secretive, defensive behavior about activities and possessions
  • Unusual mood changes
  • Abrupt temper outbursts
  • Changes in eating or sleeping habits
  • Changes in peer group or social group
  • Loss of interest in usual activities, pastimes, and hobbies
  • Aggressive or physical behavior
  • Money or valuables missing from home
  • Traveling to locations outside of normal range

Physical Signs and Symptoms

  • Rapid weight gain or loss
  • Slow or staggering walk
  • Inability to sleep or awake at unusual times
  • Unexplained bruises or marks
  • Glazed or red eyes
  • Pupils larger or smaller than usual, blank stare
  • Cold, sweaty palms or shaking hands
  • Puffy face, blushing or paleness
  • Extreme hyperactivity; excessive talkativeness
  • Runny nose, hacking cough
  • Needle marks on lower arm, leg or bottom of feet
  • Nausea, vomiting, or excessive sweating
  • Unusual nose bleeds
  • Unexplained breakout of acne/rash
  • Unusual odors
  • Low or no energy
  • Depressed or anxious
  • Deterioration of personal appearance or hygiene

Our addiction treatment providers and  professional staff are able to effectively assess and screen for addiction. A professional assessment is the best way to clinically assess the problem, establish the facts, and determine what type of treatment or recovery services offer the best opportunity for living clean and sober.

Opioid and Heroin Addiction

As declared by the National Institute on Drug Abuse and the Centers for Disease Control and Prevention, the U.S. is in the midst of an opioid epidemic. Individuals, families and communities all across the country are impacted by this crisis, which is why it’s more important than ever to understand the potential dangers of opioid use, including:

  • How prescription opioid painkillers, heroin and other opiate drugs work
  • Why opioid dependence (or heroin addiction) can develop before you realize it
  • When opioid overdose risk is greatest
  • Which treatment approaches for opioid use disorder are most effective

Let’s start with some basic definitions.

What Are Opioids?

“Opioids” is an umbrella term for natural and synthetic painkiller drugs derived from or based on the poppy plant. The related term “opiate” applies only to medications that use natural opium poppy products. For example, the illicit drug, heroin, is classified as an opiate because it is derived from the poppy plant.

Physicians often prescribe opioid medications to relieve acute pain—from injuries, surgeries, toothaches, or other medical and dental procedures—or to alleviate chronic pain. However, studies show that long-term opioid use for chronic pain can be ineffective—and comes with the risk of addiction. You might recognize some of the more well-known opioid drugs prescribed for pain, including:

  • Morphine
  • Codeine
  • Diacetylmorphine
  • Hydromorphone (Dilaudid)
  • Hydrocodone (Vicodin, Lortab)
  • Opium
  • Oxycodone (OxyContin, Percocet)
  • Oxymorphone
  • Meperidine (Demerol)
  • Methadone
  • Fentanyl (Sublimaze, Actiq)
  • Tramadol

What’s the Connection between Prescription Painkillers and Heroin?

The nation’s epidemic level of addiction to prescription opioid medications (painkillers) has given rise to the use of heroin as a less expensive, more readily accessible substitute. Heroin, a highly addictive illegal drug typically used for its euphoric effect, comes in the form of a black tar substance or a white or brown powder. Street names include “horse,” “smack,” “brown sugar” and “junk.” In the U.S., heroin use and heroin addiction are at an all-time high.

Heroin can be smoked or snorted, but the drug is more typically injected into a vein in order to achieve the quickest high. Injection causes the greatest risk to users because heroin overdose can more easily occur, and because disease and infections can be spread by dirty needles.

How Do Opioids Work, and Why Are They So Addictive?

When opioid molecules travel through the bloodstream and into the brain, they attach to opioid receptors on the surface of certain cells. The chemical response triggered in the brain’s reward center is the same as the reaction to intense pleasure and reinforces acts such as eating, drinking fluids, caring for babies and having sex—all necessary for survival of the species.

These rewarding and survival-based activities result in the release of dopamine in the brain’s reward center. But opioid use, like use of any drug of abuse, triggers the release of dopamine in excess amounts, far beyond what is needed to provide pleasure or keep us alive. In the process, the brain has been signaled: something extremely important has taken place, and it needs to be repeated.

Opioid medications can also induce euphoria, an effect that can be intensified when the drug is administered by routes other than those prescribed or recommended. For example, although the prescription painkiller OxyContin is prescribed in pill form, the medication can be snorted or injected to enhance the euphoric effects. Unintended consequences of misusing opioid drugs in this way can include serious medical problems, even opioid overdose.

Addiction is defined as the compulsive and uncontrollable use of alcohol or other drugs despite adverse consequences. Dependence occurs when the body adapts to the presence of the drug, causing withdrawal symptoms when use is reduced or discontinued.

Prolonged and increasingly higher doses of opioids change the brain so that it functions more or less normally when the drug is present and abnormally when the drug is removed. This alteration in brain function results in drug tolerance (the need to take higher and higher amounts to achieve the same effect; “chasing the dragon”) and opioid dependence (or heroin addiction) as signaled, in part, by susceptibility to withdrawal symptoms.

Euphoria is the sensation most opioid users seek, but it’s also the effect most likely to diminish with prolonged use.

That’s why it’s said a person with opioid addiction uses the drug in order to feel “normal.” And while you might assume an opioid or heroin addict takes pleasure in using, most people who develop opioid dependence cannot recall the last time their drug use was enjoyable. After a certain point, substance abuse and dependence become drudgery, and the addictive cycle becomes its own form of torture.

What Are the Signs, Symptoms and Side Effects of Opioid Addiction?

Every person’s situation is different, but in general, opioid use disorder is a condition that involves both physical and psychological processes. Progression of the disease can be so incremental that it’s not recognized as such until a crisis occurs. Here are eight potential warning signs of opioid or heroin abuse:

  1. Taking the drug in larger amounts or over a longer period than intended or prescribed
  2. A persistent desire or unsuccessful efforts to cut down or control drug use
  3. An excessive amount of time and effort spent getting, using and recovering from the effects of use
  4. Intense cravings or a strong desire or urge to use
  5. Failure to fulfill obligations at work, school or home due to drug abuse
  6. Continued use despite persistent or recurrent social or personal problems caused by usage
  7. Continued use despite situations that could be physically hazardous, including overdose risk
  8. Continued use despite awareness of potential physical or mental health problems

As with all types of drug or alcohol addiction, having a family history of substance abuse increases your risk of developing dependence.

Other signs, symptoms or side effects of prescription opioid abuse or heroin use include:

  • Problematic mental health, behavioral or psychological changes such as agitation, poor judgement or apathy
  • Drowsiness or coma
  • Impaired mental functioning
  • Slurred speech
  • Constricted pupils
  • Euphoria
  • Slowed down respiration
  • Dry mouth
  • Nausea
  • Constipation
  • Abdominal cramping
  • Skin rashes and infections
  • Weight gain
  • Menstrual problems
  • Depression
  • Headaches
  • Bad dreams
  • Loss of libido, sexual dysfunction
  • Mood swings
  • Collapsed veins
  • Risk of HIV, hepatitis B or C
  • Miscarriage
  • Infections of the heart lining and valves

What Are the Warning Signs of Opioid Overdose?

Taking a large, single dose of heroin or any opioid drug can cause severe respiratory depression with the potential for accidental drug overdose and death. Opioid abuse is also associated with a higher risk of suicide. Signs of overdose may include:

  • Shallow breathing
  • Pinpoint pupils
  • Convulsions
  • Coma
  • Nervous system changes
  • Decreased vital signs
  • Cold or clammy skin, or bluish lips

The strength of heroin is unpredictable because other drugs, such as fentanyl, are sometimes added to increase volume or enhance potency. Heroin is one of the substances most frequently reported by medical examiners in drug abuse deaths.

What Is Opioid Withdrawal?

Opioid withdrawal occurs as the body adjusts to a decrease or discontinuance in drug use. The withdrawal effects can be especially challenging and, in fact, prevent some people with addiction from seeking the help they need and deserve. Opioid withdrawal symptoms include:

  • Restlessness
  • Muscle aches, pain, stiffness, spasms and bone pain
  • Insomnia
  • Diarrhea
  • Vomiting
  • Cold flashes with goose bumps (“cold turkey”)
  • Involuntary leg movements
  • Agitation
  • Anxiety, panic
  • Itching
  • Irritability
  • Rapid heart rate
  • Mild hypertension
  • Runny nose
  • Sweating, shaking
  • Flu-like symptoms, fever
  • Yawning
  • Seizures
  • Sleep difficulties
  • Fear, paranoia

At the height of opiate withdrawal, symptoms typically include intense anxiety, tremors, shakes and muscle cramps. Joint ache and deep bone pain often manifest, as well.

The long-term consequences of opiate withdrawal, including anxiety, depression and cravings, can continue for months, even years after being free of use. Recovering addicts may also have an increased sensitivity to real or imagined pain, and greater vulnerability to stressful events.

The desire to feel “normal” again, to escape the seemingly permanent state of dysphoria, puts recovering opioid addicts at a high risk of relapse and, even more tragically, at a high risk of accidental overdose, respiratory suppression and death. When people with opioid dependence stop using—for weeks or months or years—and then pick up again, their tolerance for the drug changes so that an amount they could previously tolerate can become a lethal dose.

What Is the Most-Effective Treatment for Opioid Addiction?

Given the unique treatment and recovery challenges associated with heroin addiction, including challenging withdrawal symptoms and an increased vulnerability to relapse and accidental death, clinicians at the Get Addiction Care  developed an evidence-based opioid addiction treatment protocol that includes the use of certain medications, an extensive level of continuing care and close monitoring of medication use. Known as Comprehensive Opioid Response  the approach is designed to provide patients with a sufficiently long enough time in treatment programming to begin forming healthy new practices and taking in new information essential to recovery. Treatment programming is delivered within the context of evidence-based therapies, with abstinence from drug use as the ultimate goal.

As part of the COR-12 treatment protocol, physicians work with the patient to determine the treatment course that best fits his or her clinical needs. Patients may receive Suboxone®, a combination of buprenorphine and naloxone, during detox to ease withdrawal symptoms. Some patients may receive a recommendation for a monthly, extended-release injection of the medication Vivitrol®, also known as naltrexone, to block cravings and help prevent relapse. Although methadone is commonly used to ease opioid and heroin withdrawal, we provide buprenorphine instead, for a number of important reasons. Buprenorphine has been deemed a better medication for our patient population, in keeping with the goal of transitional use of medication-assisted treatment versus long-term medication maintenance. Learn more about methadone vs Suboxone (buprenorphine with naloxone) for treatment of opiate addiction and withdrawal.

Alcohol Addiction

Alcohol addiction is a medical disorder, one that destroys both the lives of the person living with the issue and the lives of those who love them.

Mental health, physical health and emotional health all deteriorate when chronic alcohol abuse is an issue. Because the Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies alcohol addiction as a psychiatric disorder, it is recommended that alcoholics and those struggling with alcohol abuse and binge drinking seek medical treatment in order to learn how to live a life that is free from alcohol.

Who Needs Alcohol Addiction Treatment?

Alcohol addiction strikes men and women, young and old, rich and poor. Trends in alcohol use and types of alcohol abuse may vary, but the result is the same: serious health problems and a deadly addiction. According to the National Institute on Alcohol Abuse and Alcoholism, even those who are legally too young to drink have a problem with alcohol; as many as 13 percent of 8th graders, 28 percent of 10th graders, and

41 percent of high school seniors reported past alcohol use. Additionally, 5 percent of 8th graders, almost 15 percent of 10th graders, and more than 26 percent of 12th graders reported having been drunk.

Who needs alcohol addiction treatment? Anyone who is unable to stop drinking despite the negative consequences – and when alcohol addiction is an issue, it negatively impacts every aspect of life.

What Is the Difference Between Alcohol Abuse and Alcohol Addiction?

According to PubMed Health, alcohol abuse and alcoholism are two different types of drinking, but both are problematic for the drinker.

When alcohol abuse is an issue, it causes problems for the drinker in every day life – legal issues, financial woes, health ailments, etc. – but it does not cause physical addiction. When alcohol dependence is an issue, it is defined by both a psychological and a physical addiction to alcohol that controls every choice and action of the drinker. Both issues are treatable at alcohol rehab.

When Does Alcohol Addiction Mean a Dual Diagnosis?

When the patient is living with both alcohol dependence and a mental health diagnosis like depression, anxiety, bipolar disorder, schizophrenia and other disorders, then a Dual Diagnosis is present. According to the National Institutes of Health, alcoholics are two to three times more likely than the general public to be diagnosed with an anxiety disorder. Additionally, a National Institute of Alcohol Abuse and Alcoholism study found that patients with a history of alcohol addiction were more than four times as likely to experience a major depressive episode as those without a history of alcohol abuse and addiction.

How Is a Dual Diagnosis Treated?

When a patient is dealing with issues related to both an alcohol addiction and a mental health disorder, it is necessary to receive medical treatment for both problems at the same time. In the past, it was believed that addiction should be treated first and the mental health issue should be treated second. However, it was quickly found that it was almost impossible for Dual Diagnosis patients to avoid relapse in early recovery when they weren’t receiving treatment for their mental health symptoms.

Body-Dysmorphic-Disorder3-300x450

Often, patients originally turned to alcohol in an effort to self-medicate their mental health issues, and these untreated symptoms can serve as a trigger for relapse without effective medical and psychotherapeutic intervention.

Get the information you need to effectively address issues of alcohol addiction and mental health symptoms when you contact us at the phone number listed above. Dual Diagnosis treatment can be just what you need to effectively heal.

Opioid and Heroin Addiction

What Is Crystal Meth?

Crystal methamphetamine is a synthetic psychostimulant drug that speeds up the inner working of the brain and affects the central nervous system, with long-lasting effects on the body. Nicknames include crystal, speed, zoom, go, crank, tweak, ice, glass, rock candy, shizzo, yaba, fire, uppers, poor man’s cocaine or shards. Some people call it Tina when out in public, because it sounds like they’re talking about a girl rather than a drug. Crystal methamphetamine can be swallowed as a pill, injected intravenously, snorted or smoked, and can either look like little shards of glass or an odorless, bitter-tasting powder, ranging in color from clear to pink, or off-white to brown, depending on the ingredients used to make it. The drug has devastating effects on those who become dependent. According to The Meth Project Foundation, the methamphetamine addiction factor is extreme—it’s “one of the most addictive substances” out there today.

How Did We Get to This Point?

Today’s prevalence of crystal meth addiction can be traced to the development of amphetamine and methamphetamine drugs more than a century ago. Amphetamine was first synthesized in Germany in 1887, when ephedrine was isolated from the ephedra shrub. In 1919, crystallized methamphetamine was produced in Japan. A derivative of amphetamine, methamphetamine was two to three times more potent as a stimulant, its effects lasted much longer and it was easier to make. Crystal methamphetamine was also more addictive and more toxic. Because so little was known about the negative side effects and addictive nature, meth tablets were distributed to German soldiers during World War II so they could fight day and night without eating or sleeping, according to the Science History Institute.

Military-grade amphetamine was also readily available to British and American soldiers to “combat fatigue and boost morale.”

By the 1950s, amphetamine, marketed as Benzedrine, was widely used to treat asthma, hayfever and colds. Recreational use grew as well. During the Vietnam War, amphetamine, nicknamed “pep pills,” was issued to American soldiers to “increase alertness” during lengthy jungle expeditions. Once the drug wore off, many soldiers reported feeling anxious, angry and aggressive.

By 1971, the United States Drug Enforcement Administration (USDEA) recognized all amphetamines as Schedule II controlled substances, citing the potential for abuse and dependence. According to the Journal of Psychopharmacology, amphetamine today is a “highly restricted” Food and Drug Administration-controlled nervous system stimulant, prescribed to treat attention deficit hyperactivity disorder and narcolepsy (common drugs are Adderall and Dexedrine). The pure form of methamphetamine, Desoxyn, is rarely ever prescribed in the U.S. In some countries, it’s banned for prescription purposes.

How Is Crystal Meth Made? What’s in It?

With amphetamine placed under federal control, illegal drug suppliers found that ephedrine, used in over-the-counter cold medicine, produces methamphetamine, according to Frontline. It didn’t take long for crystal meth to become “discovered” in the 1980s. Unlike cocaine and heroin, which are also sold illegally, methamphetamine is made with household products including lithium from car batteries, brake fluid, drain cleaner/toilet cleaner (sulfuric or hydrochloric acid), nail polish remover/paint thinner (acetone), fertilizers (ammonia), fuel, red phosphorous, lye (sodium hydroxide—used “to dispose of road kill because it turns the dead bodies into a coffee-like liquid,” according to methproject.org ) or antifreeze. According to the Foundation for a Drug-Free World, the substance is often made in illegal makeshift labs within homes, cabins, cars, shacks, motels, etc. The ignitable, corrosive and toxic nature of the chemicals used to create crystal meth can cause fires, produce toxic vapors and wreak havoc on the environment. It’s basically a concoction of toxic waste—a poison.

What Happens When You’re on Crystal Meth?

Users of crystal meth report initially feeling euphoric, experiencing an intense, long-lasting rush after the first use. This is because methamphetamine floods the brain with dopamine, the “feel good” chemical responsible for pleasure, reward and motivation. Blood pressure spikes, thoughts race, users often have to keep moving even though they’re accomplishing nothing. “While under the influence of meth, users can have the illusion of being more powerful and productive than usual, and than they actually are. Although this can feel good to the meth user, it can cause real problems. Meth can make people feel more socially outgoing, talkative and self-confident. But equally, they can behave bizarrely and become distant from positive social relationships, and not realize they may appear ridiculous to others,” explains Elizabeth Hartney, PhD, in Very Well Mind.

After the rush comes the high. If snorting the drug in crystal form, the high will come on in three to five minutes; if swallowing methamphetamine, it can take 15 to 20 minutes. The length of time the drug stays in your system depends on how much was used, your age (as you get older, your body has a slower metabolism, and it can take longer to eliminate toxins), and your health (if you’re unhealthy, it will take longer for your body to get rid of substances). The drug’s effects can last anywhere from six to12 hours, which can lead people to continue using to keep the high going. Users who binge on crystal meth can stay awake for as long as 10 days, often subsisting with very little food or drink.

“Tweaking” occurs when the body and mind of the meth addict stop reacting to the drug, and the addict “enters a state that is almost psychotic,” according to Methamphetamine Addiction.

“Tweakers” can be unpredictable, with the user experiencing hallucinations; paranoia; and picking, scraping, or digging at the face or skin, either due to breakouts or because they feel phantom bugs crawling on or under the skin’s surface (“ice bugs” or “meth sores”). This crawling feeling is due to an increased body temperature, leading to sweating and oily skin, combined with the fact that the body is dehydrated.

The stimulant can also bring about a severe crash when the inebriating effects wear off, causing the user to sleep for days afterward.

Common physical effects of “coming down” from the drug use include body aches, heart burn, and feeling extremely lethargic, nauseous and confused. When meth wears off, dopamine and serotonin are both depleted, resulting in anxiety and depression.

Meth addiction is a vicious cycle. Once you develop a tolerance to the drug, it takes more and more methamphetamine to achieve the same stimulating effect. A second consequence is that when the high is over, the user feels a corresponding low or depression as a result of a depleted supply of dopamine. Users are well aware that such feelings can quickly be countered by another dose. While the depths of this low tend to correspond to the heights of the user’s high, the long-term reduction in dopamine levels for people with meth addiction leads to anhedonia, the inability to experience pleasure from simple, everyday things.

How Can You Tell Someone Is Using Crystal Meth?

The mugshots don’t lie. There are many physical side effects of long-term meth abuse, such as tooth decay or “meth mouth,” body sores, weight loss, hair loss and outward signs of aging as the drug destroys tissues and blood vessels. Because chronic meth use can induce pathological brain changes—basically altering the chemistry of the brain—psychological side effects can include violent aggression, obsessive thoughts and behaviors, even psychosis, a mental health disorder affecting a person’s thoughts and emotions. (Some meth addicts are misdiagnosed as having a mental illness such as schizophrenia.) Psychosis can cause extreme paranoia, delusions and hallucinations, including the feeling of one’s skin “crawling” with imaginary parasites. According to the National Institute on Drug Abuse, psychosis can last for several months or years after the individual quits using. One evidence-based report in Current Psychiatry reported that, among chronic methamphetamine users, “partial recovery of neuropsychological functioning and improvement in affective distress can be achieved after sustained abstinence from methamphetamine, but recovery may not be complete.”

Side effects and signs of meth addiction may include:

  • Decreased appetite (crystal meth affects serotonin levels in the brain, responsible for regulating mood, appetite and memory)
  • Increased wakefulness and obsessive physical activity
  • Psychosis/psychotic episodes
  • Euphoria
  • Increased sensitivity to noise
  • Nervous activity, like scratching or picking at the skin
  • Irritability, dizziness or confusion
  • Depression
  • Tremors or convulsions
  • Anxiety
  • Chronic fatigue
  • Paranoia
  • Increased heart rate, blood pressure and risk of stroke; irregular heartbeat
  • Mood swings or outbursts, including aggression and violent behavior
  • Risk of HIV/AIDS
  • Hyperthermia (overheating of the body)
  • Dry mouth
  • “Meth mouth” (broken, decayed, stained teeth)
  • Incessant itching
  • Dilated pupils
  • Rapid eye movement
  • Twitching
  • Small wounds from the injection site (“speed bumps”)

Meth paraphernalia/signs of use:

  • Water pipes
  • Burned spoons
  • Aluminum foil
  • Rolled up paper slips
  • Needles, syringes, shoelaces, rubber tubing (used as a tourniquet if shooting up)

Long Term Effects of Meth Use

It’s not an exaggeration to describe the long-term effects of meth use as profound. According to the National Institute on Drug Abuse, crystal meth can damage nerve terminals and increase the risk for physical and psychological illness (such as Parkinson’s disease). Meth abuse can cause irreversible damage to blood vessels in the brain. Use of the drug can also cause birth defects, profound weight loss and cardiovascular issues, including cardiac arrhythmia, myocardial infarction, stroke, seizures, extreme and unhealthy weight loss, and even death.

Why Is Crystal Meth so Addictive?

Curiosity, boredom, peer pressure, weight loss, to fill a void—the reasons vary for why people try meth for the first time. The common thread of advice among many methamphetamine addicts, though, is don’t try it at all. Walk away. It’s not worth the risk of getting hooked after just one use. Devastating consequences can come with that first hit. The body can quickly become dependent on the chemicals, leading to methamphetamine addiction.

Is There a Cure for Meth Addiction?

There is no quick and easy cure for meth abuse/addiction, but substance use disorders can be treated with physical and psychological methods. Addiction treatment program options include medically supervised detox, inpatient treatment, outpatient treatment, partial hospitalization, aftercare and relapse prevention.

What Are Meth Withdrawal Symptoms?

The most common symptoms of meth withdrawal can be intense. It’s recommended that those going through withdrawal do so under professional supervision at a trusted meth addiction treatment center. The following are common withdrawal symptoms for chronic meth users:

  • Fatigue
  • Depression
  • Insomnia
  • Intense cravings (this can last up to 10 weeks)

Once the meth cravings fade, the patient can begin to engage in treatment programming.

Types of Addiction Treatment

The most effective meth addiction treatment programs include medical detox and cognitive therapies. As reported in Current Psychiatry, “Because cognitive dysfunction can influence treatment outcomes, clinicians need to be fully aware of the cognitive status of those patients, and a thorough neuropsychological evaluation is necessary before initiating treatment.” Cognitive-behavioral therapy focuses on understanding the role of substance abuse in a person’s life and fosters the development of coping skills to avoid addiction relapse. When addressing substance abuse, the National Institute on Drug Abuse describes cognitive-behavioral strategies as “learning to identify and correct problematic behaviors by applying different skills to stop drug abuse.” By recognizing cravings early on and identifying situations that might put a person at risk, the individual can develop effective coping strategies.

At Get Addiction Care  evidence-based approaches to drug addiction treatment are utilized by a licensed and accredited multidisciplinary care team. Our treatment program options include cognitive-behavioral therapy,