- No single treatment is appropriate for all individuals.
Matching treatment settings, interventions, and services to
each individual's particular problems and needs is critical
to his or her ultimate success in returning to productive
functioning in the family, workplace, and society.
- Treatment needs to be readily available. Because
individuals who are addicted to drugs may be uncertain about
entering treatment, taking advantage of opportunities when
they are ready for treatment is crucial. Potential treatment
applicants can be lost if treatment is not immediately
available or is not readily accessible.
- Effective treatment attends to multiple needs of the
individual, not just his or her drug use. To be
effective, treatment must address the individual's drug use
and any associated medical, psychological, social,
vocational, and legal problems.
- An individual's treatment and services plan must be
assessed continually and modified as necessary to ensure
that the plan meets the person's changing needs. A
patient may require varying combinations of services and
treatment components during the course of treatment and
recovery. In addition to counseling or psychotherapy, a
patient at times may require medication, other medical
services, family therapy, parenting instruction, vocational
rehabilitation, and social and legal services. It is
critical that the treatment approach be appropriate to the
individual's age, gender, ethnicity, and culture.
- Remaining in treatment for an adequate period of time
is critical for treatment effectiveness. The appropriate
duration for an individual depends on his or her problems
and needs (see pages 11-49). Research indicates that for
most patients, the threshold of significant improvement is
reached at about 3 months in treatment. After this threshold
is reached, additional treatment can produce further
progress toward recovery. Because people often leave
treatment prematurely, programs should include strategies to
engage and keep patients in treatment.
- Counseling (individual and/or group) and other
behavioral therapies are critical components of effective
treatment for addiction. In therapy, patients address
issues of motivation, build skills to resist drug use,
replace drug-using activities with constructive and
rewarding nondrug-using activities, and improve
problem-solving abilities. Behavioral therapy also
facilitates interpersonal relationships and the individual's
ability to function in the family and community. (Approaches
to Drug Addiction Treatment section discusses details of
different treatment components to accomplish these goals.)
- 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) are very effective in
helping individuals addicted to heroin or other opiates
stabilize their lives and reduce their illicit drug use.
Naltrexone is also an effective medication for some opiate
addicts and some patients with co-occurring alcohol
dependence. For persons addicted to nicotine, a nicotine
replacement product (such as patches or gum) or an oral
medication (such as bupropion) can be an effective component
of treatment. For patients with mental disorders, both
behavioral treatments and medications can be critically
- Addicted or drug-abusing individuals with coexisting
mental disorders should have both disorders treated in an
integrated way. Because addictive disorders and mental
disorders often occur in the same individual, patients
presenting for either condition should be assessed and
treated for the co-occurrence of the other type of disorder.
- Medical detoxification is only the first stage of
addiction treatment and by itself does little to change
long-term drug use. Medical detoxification safely
manages the acute physical symptoms of withdrawal associated
with stopping drug use. While detoxification alone is rarely
sufficient to help addicts achieve long-term abstinence, for
some individuals it is a strongly indicated precursor to
effective drug addiction treatment (see
Drug Addiction Treatment Section).
- Treatment does not need to be voluntary to be
effective. Strong motivation can facilitate the
treatment process. Sanctions or enticements in the family,
employment setting, or criminal justice system can increase
significantly both treatment entry and retention rates and
the success of drug treatment interventions.
- Possible drug use during treatment must be monitored
continuously. Lapses to drug use can occur during
treatment. The objective monitoring of a patient's drug and
alcohol use during treatment, such as through urinalysis or
other tests, can help the patient withstand urges to use
drugs. Such monitoring also can provide early evidence of
drug use so that the individual's treatment plan can be
adjusted. Feedback to patients who test positive for illicit
drug use is an important element of monitoring.
- 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 themselves or others at risk
of infection. Counseling can help patients avoid
high-risk behavior. Counseling also can 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.
Addicted individuals may require prolonged treatment and
multiple episodes of treatment to achieve long-term
abstinence and fully restored functioning. Participation in
self-help support programs during and following treatment
often is helpful in maintaining abstinence.