There is little evidence that depression or suicide rates rise during the holidays, but the season is certainly known for its excesses. Although just as many people (if not more) need help for drug and alcohol addiction, fewer people reach out for treatment in the last couple months of the year. Addicts generally object to being away from home during family gatherings at Thanksgiving or Christmas, but for some families, seeking help during the holidays could be the greatest gift you give this year. Here are a few ironies that keep addicts sick over the holidays:

#1 Drug use is more common yet people are less likely to get help.

Even in the face of serious consequences, some addicts put off getting help so that they can get through the holiday festivities without disappearing off to rehab. Some party even harder around the holidays, flying under the radar of loved ones because it is socially acceptable to overdo the celebrating. Unfortunately, the stress of the season can exacerbate substance abuse, leaving an addict spiraling out of control.

The day before Thanksgiving, described in the media as Black Wednesday, is one of the biggest partying nights of the year, with the National Health Institute estimating that 10.8 million underage drinkers binge that day. According to Nielsen reports, alcohol consumption increases dramatically in December and in the week leading up to the New Year. All of this alcohol fuels as much as a 25 percent increase in alcohol-related traffic incidents, prompting President Barack Obama to declare December National Impaired Driving Prevention Month.

When people arrive at an addiction treatment center, they typically don’t want to be there. They’re agitated and apprehensive, and they doubt whether they even have a problem, especially one that is as bad as their families, employers or the courts believe.

In many cases, the last thing they want to do is sit down for talk therapy or attend a support meeting, though both are essential elements of treatment. What they do want is relief from the discomfort of withdrawal.

There is no better way to begin building rapport with a client – and to keep them in treatment – than to listen attentively and help them feel better as quickly as possible. This is where complementary and alternative therapies can be of great value to the addict, particularly in the early stages of recovery.

Whether a client agrees with the therapist’s perspective or not, they are appreciative of any intervention that addresses their insomnia, anxiety, muscle cramps and other withdrawal symptoms. Not only are these symptoms unpleasant, but they are also major factors in relapse.

Once the therapist shows an interest in the problem as the addict defines it, the addict is more willing to talk about the problem as the therapist defines it. And so a relationship begins.

Last month, The National Center on Addiction and Substance Abuse (CASA) at Columbia University released a five-year study assessing the state of addiction treatment in the U.S. Among other findings, CASA reported that only one in 10 people in need of addiction treatment get it, and of those who do, most “do not receive anything that approximates evidence-based care.”

Evidence-based care does exist in a minority of treatment centers, but how does one go about finding it? What exactly is evidence-based care? In short, evidence-based care is treatment that is backed by scientific research. According to CASA, it includes the following elements:

Comprehensive Assessments – To understand each individual’s specific needs, CASA advises physicians and other health professionals to complete a comprehensive assessment. This assessment should evaluate the individual’s medical, psychological, social, family and substance use history, current health status, addictive behaviors, personality traits, and the presence of any co-occurring disorders.

Based on this assessment, the team develops an individualized treatment plan that contains specific goals and interventions. As the patient’s needs change, the treatment plan is revised accordingly.

More people are addicted to drugs now than any time in our nation’s history. Addiction has become public enemy number one, and the search is on for new treatments. Surgeries, pills, vaccines – we’re willing to try anything if it means putting an end to the suffering. But has science gone too far?

Here are five of the most controversial addiction treatments that beg the question, “Is this the best we can do?”

#1 Methadone and Suboxone

Methadone and Suboxone are opioids that have been well-studied and widely used to minimize withdrawal symptoms and cravings in opiate addicts. By removing addicts from the junkie lifestyle, these medications have been marketed as a solution to a life of crime, sickness, unemployment and poverty, with minimal side effects and a more affordable price tag than rehab.

Why the Controversy: Once believed to be a “cure” for opiate addiction, the drawbacks to these medications have become clear over time. Both medications are addictive and difficult to wean off of because of severe withdrawal symptoms. Although Suboxone is generally preferred over methadone because it reduces the risk of addiction and overdose and blocks the effects of other opiates, neither medication addresses the complex underlying causes of addiction. This means that counseling, self-help groups and other treatments are still essential for long-term success.

As a result of numerous outcome studies conducted in the past decade, there is a growing consensus that for those who can manage it, long-term addiction treatment is the most effective option. We frequently meet the addict who bounces from 30-day rehab to 30-day rehab, only to hold onto their sobriety after staying in treatment for many months.

Thirty days of residential treatment used to be the generally accepted standard in treatment. Why 30? Not because research showed its effectiveness, but because that was the average length of stay covered by insurance. Now, the National Institute of Drug Abuse has declared 90 days of treatment the “gold standard.”

This is because research shows that people completing at least 90 days of treatment have significantly lower relapse rates than those who stay for shorter amounts of time.

Why Longer Is Better

It’s difficult for people to commit to 30 days away from their families and jobs, not to mention 90-plus days, but addiction is a chronic, relapsing disease that takes time and ongoing effort to address. Longer treatment stays offer the following benefits:

• Detox Doesn’t Dominate. Depending on the individual and their drug history, detox may take up a significant portion of a 30-day drug rehab program. And while detox is a critical part of the process, it is not in itself treatment. With a longer treatment stay, clients still have several weeks or more following detox to engage in the deeper work of recovery.

Drug rehab is both an opportunity and an investment. Like all investments, it can be strategically planned and implemented, or it can be an opportunity squandered.

Even if you have all the resources you could hope for and choose the most respected program in the country, no drug rehab can do the work of recovery for you. Here are a few tips for getting the most out of your time in drug rehab:

Stay Positive. People often come into rehab feeling defeated and hopeless, especially if they have been through treatment before and relapsed. Celebrating your willingness to try again and the courage it takes to ask for help can set a positive tone for your recovery.

High-functioning alcoholics and addicts are hard to get into treatment, and pose unique treatment challenges once they arrive. What makes the high-functioning addict so difficult to reach?

Challenge #1: Denial

Denial is perhaps the greatest obstacle to getting a high-functioning addict into treatment. High-functioning addicts are often intelligent and persuasive, characteristics that are used by the disease to justify maintaining their addiction. Because they do not fit the stereotype of a drug addict, feel that their lives are manageable, and haven’t hit “rock bottom,” many HFAs insist they do not need help.

They lie, argue and manipulate their way out of addiction and rationalize their behaviors, often so effectively that loved ones and colleagues question their own observations.

Overcome it: It takes a skilled interventionist and experienced treatment team to help the HFA overcome their sophisticated system of denial and accept their powerlessness over addiction. An intervention allows the HFA to experience the full consequences of their behaviors and helps them understand the impact their addiction has had on the people closest to them.

In an ideal world, every addict that arrives in drug rehab would be cognizant of their disease and determined to get well. But when dealing with addiction, ideal situations are rare.

There is ongoing debate about whether an addict who doesn’t want help can be helped. Many believe that only the addict can help themselves. They have to want to quit. But in the midst of active addiction, few addicts want to quit. In fact, most addicts are, by their very nature, unwilling patients.

Changes in the brain, which has been hijacked by drugs, leave the addict powerless to truly see themselves and make rational decisions. Because they have come to depend on drugs to function, they will make excuses, justify the indefensible and put off treatment as long as possible.

There are many ways in which addicts are pushed into treatment: court order, divorce, loss of child custody and hospitalization, to name a few. While some flounder along the way, many go on to achieve lifelong sobriety regardless of the fact that entering treatment wasn’t entirely “voluntary.”

Most addicts develop the motivation to sustain their recovery after being helped into treatment, when they start learning about their disease and feeling better than they have since they started using. We have techniques for getting addicts into treatment that work, if not right away then over time, even in the seemingly most hopeless situations.

So how can family, friends and colleagues help the unwilling addict?

Rage. Instability. Mood swings. Impulsivity. These characteristics make people with borderline personality disorder (BPD) prone to substance abuse as well as over-spending, promiscuity, eating disorders and other compulsive behaviors. In fact, studies suggest that 50 to 70 percent of those with BPD also have a co-occurring substance use disorder.

Addicts with co-occurring borderline personality disorder are known as some of the most difficult patients to treat. Here are a few of the most common challenges, along with insights into the most effective research-based treatments:

Treatment Compliance

Addicts with BPD have been described as both treatment demanding and treatment resistant. Research shows more positive outcomes the longer an addict with BPD stays in treatment, yet keeping them in treatment is no easy task. In a study of patients in a detox program, those with BPD were significantly more likely to have an unplanned discharge than those without BPD.

While a number of treatments have proven effective for BPD, therapies for BPD patients with co-occurring substance abuse are less established. Studies suggest that the most promising treatments include dialectical behavior therapy, cognitive-behavioral therapy and psychodynamic approaches. A combination of support and management from an experienced dual diagnosis treatment center can improve retention rates, along with ongoing involvement in self-help groups such as AA and NA.

Getting an addict into drug rehab isn’t always an easy task. Getting them to stay there can be even harder. Here are five of the most common reasons people leave drug rehab against medical advice, along with suggestions to help the addict stay committed to their recovery.

1. “Detox is too painful.”

Research shows that the first week of drug rehab is the time when most addicts ask themselves, “What the heck am I doing here?” Withdrawal symptoms, drug cravings and an unfamiliar environment can fill the addict with anxiety at the same time they are deprived of their primary coping mechanism: drugs. Some addicts rationalize that they felt better when using drugs and give up on rehab before treatment really begins.

Prevention Tip: Detox can be made more comfortable with medication and alternative therapies such as neurofeedback, acupuncture and massage. Even if the addict isn’t feeling great, they should try to get involved in as many treatment activities as possible.

Rather than isolating, their peers will help them realize they are not alone and see the hope that treatment brings. The earlier the addict develops trust and rapport with a therapist, the more likely they will listen to the therapist’s recommendations and push through the uncertainty.