The National Institute on Drug Abuse, the federal agency responsible for nearly all of the research on drug abuse, recently published the following principles which were developed and reflect what the research to date demonstrates about drug treatment. These program elements represent the state of the art treatment essentials, as we currently understand them.
If you are researching a
treatment program for yourself, or trying to assist a loved one in
accessing a treatment program, you may want to ask very specific
questions about these elements and whether their programs incorporate
these principles to help you make the best choice possible.
Treatment needs to be readily available. Treatment applicants can be lost if treatment is not immediately available or readily accessible.
Effective treatment attends to multiple needs of the individual
, not just his or her drug use. Treatment must address the individual's
drug use and associated medical, psychological, social, vocational, and
legal problems.
Treatment needs to be flexible and to provide ongoing
assessments of patient needs, which may change during the course of
treatment.
Remaining in treatment for an adequate period of time is
critical for treatment effectiveness. The time depends on an
individual's needs. For most patients, the threshold of significant
improvement is reached at about 3 months in treatment. Additional
treatment can produce further progress. Programs should include
strategies to prevent patients from leaving treatment prematurely.
Individual and/or group counseling and other behavioral
therapies are critical components of effective treatment for addiction.
In therapy, patients address motivation, build skills to resist drug
use, replace drug-using activities with constructive and rewarding non
drug-using activities, and improve problem-solving abilities.
Behavioral therapy also facilitates interpersonal relationships.
Medications are an important element of treatment for many
patients, especially when combined with counseling and other behavioral
therapies. Methadone and levo-alpha-acetylmethadol (LAAM) help persons
addicted to opiates stabilize their lives and reduce their drug use.
Naltrexone is effective for some opiate addicts and some patients with
co-occurring alcohol dependence. Nicotine patches or gum, or an oral
medication, such as bupropion, can help persons addicted to nicotine.
Addicted or drug-abusing individuals with coexisting mental
disorders should have both disorders treated in an integrated way.
Because these disorders often occur in the same individual, patients
presenting for one condition should be assessed and treated for the
other.
Medical detoxification is only the first stage of addiction
treatment and by itself does little to change long-term drug use.
Medical detoxification manages the acute physical symptoms of
withdrawal. For some individuals it is a precursor to effective drug
addiction treatment.
Treatment does not need to be voluntary to be effective.
Sanctions or enticements in the family, employment setting, or criminal
justice system can significantly increase treatment entry, retention,
and success.
Possible drug use during treatment must be monitored
continuously. Monitoring a patient's drug and alcohol use during
treatment, such as through urinalysis, can help the patient withstand
urges to use drugs. Such monitoring also can provide early evidence of
drug use so that treatment can be adjusted.
Treatment programs should provide assessment for HIV/AIDS,
hepatitis B and C, tuberculosis and other infectious diseases, and
counseling to help patients modify or change behaviors that place them
or others at risk of infection. Counseling can help patients avoid
high-risk behavior and help people who are already infected manage
their illness.
Recovery from drug addiction can be a long-term process and frequently
requires multiple episodes of treatment. As with other chronic
illnesses, relapses to drug use can occur during or after successful
treatment episodes. Participation in self-help support programs during
and following treatment often helps maintain abstinence.
From: Principles of Drug Addiction Treatment: A Research-based Guide
(NCADI publication BKD347)