The ultimate goal of drug addiction treatment is to enable an
individual to achieve lasting abstinence, but the immediate
goals are to reduce drug abuse, improve the patient's ability to
function, and minimize the medical and social complications of
drug abuse and addiction. Like people with diabetes or heart
disease, people in treatment for drug addiction will also need
to change their behavior to adopt a more healthful lifestyle.
In 2006, 23.6 million persons aged 12 or older needed
treatment for an illicit drug or alcohol use problem (9.6
percent of the persons aged 12 or older). Of these, 2.5 million
(10.8 percent of those who needed treatment) received treatment
at a specialty facility. Thus, 21.2 million persons (8.6 percent
of the population aged 12 or older) needed treatment for an
illicit drug or alcohol use problem but did not receive it.
These estimates are similar to the estimates for 2005.*
Untreated substance abuse and addiction add significant costs
to families and communities, including those related to violence
and property crimes, prison expenses, court and criminal costs,
emergency room visits, healthcare utilization, child abuse and
neglect, lost child support, foster care and welfare costs,
reduced productivity, and unemployment.
The cost to society of illicit drug abuse alone is $181 billion annually.1 When combined with alcohol and tobacco costs, they exceed $500 billion including healthcare, criminal justice, and lost productivity.2,3 Successful drug abuse treatment can help reduce these costs in addition to crime, and the spread of HIV/AIDS, hepatitis, and other infectious diseases. It is estimated that for every dollar spent on addiction treatment programs, there is a $4 to $7 reduction in the cost of drug-related crimes. With some outpatient programs, total savings can exceed costs by a ratio of 12:1.
Basis for Effective Treatment
Scientific research since the mid-1970s shows that treatment
can help many people change destructive behaviors, avoid
relapse, and successfully remove themselves from a life of
substance abuse and addiction. Recovery from drug addiction is a
long-term process and frequently requires multiple episodes of
treatment. Based on this research, key principles have been
identified that should form the basis of any effective treatment
program:
- No single treatment is appropriate for all individuals.
- Treatment needs to be readily available.
- Effective treatment attends to multiple needs of the
individual, not just his or her drug addiction.
- An individual’s treatment and services plan must be
assessed often and modified to meet the person’s changing
needs.
- Remaining in treatment for an adequate period of time is
critical for treatment effectiveness.
- Counseling and other behavioral therapies are critical
components of virtually all effective treatments for
addiction.
- For certain types of disorders, medications are an
important element of treatment, especially when combined
with counseling and other behavioral therapies.
- Addicted or drug-abusing individuals with coexisting
mental disorders should have both disorders treated in an
integrated way.
- Medical management of withdrawal syndrome is only the
first stage of addiction treatment and by itself does little
to change long-term drug use.
- Treatment does not need to be voluntary to be effective.
- Possible drug use during treatment must be monitored
continuously.
- Treatment programs should provide assessment for
HIV/AIDS, hepatitis B and C, tuberculosis, and other
infectious diseases, and should provide counseling to help
patients modify or change behaviors that place themselves or
others at risk of infection.
- As is the case with other chronic, relapsing diseases,
recovery from drug addiction can be a long-term process and
typically requires multiple episodes of treatment, including
"booster" sessions and other forms of continuing care.
Effective Treatment Approaches
Medication and behavioral
therapy, alone or in combination, are aspects of an overall
therapeutic process that often begins with detoxification,
followed by treatment and relapse prevention. Easing withdrawal
symptoms can be important in the initiation of treatment;
preventing relapse is necessary for maintaining its effects. And
sometimes, as with other chronic conditions, episodes of relapse
may require a return to prior treatment components. A continuum
of care that includes a customized treatment regimen, addressing
all aspects of an individual's life, including medical and
mental health services, and follow up options (e.g., community-
or family-based recovery support systems) can be crucial to a
person’s success in achieving and maintaining a drug-free
lifestyle.
Medications can
be used to help with different aspects of the treatment process.
Withdrawal: Medications offer help
in suppressing withdrawal symptoms during detoxification.
However, medically assisted withdrawal is not in itself
"treatment"—it is only the first step in the treatment process.
Patients who go through medically assisted withdrawal but do not
receive any further treatment show drug abuse patterns similar
to those who were never treated.
Treatment: Medications can be used
to help re-establish normal brain function and to prevent
relapse and diminish cravings throughout the treatment process.
Currently, we have medications for opioid (heroin, morphine) and
tobacco (nicotine) addiction, and are developing others for
treating stimulant (cocaine, methamphetamine) and cannabis
(marijuana) addiction.
Methadone and buprenorphine, for example, are effective
medications for the treatment of opiate addiction. Acting on the
same targets in the brain as heroin and morphine, these
medications suppress withdrawal symptoms, and relieve craving
for the drug. This helps patients to disengage from drug-seeking
and related criminal behavior and be more receptive to
behavioral treatments.
Buprenorphine: This is a relatively
new and important treatment medication. NIDA-supported basic and
clinical research led to its development (Subutex or, in
combination with naloxone, Suboxone), and demonstrated it to be
a safe and acceptable addiction treatment. While these products
were being developed in concert with industry partners, Congress
passed the Drug Addiction Treatment Act (DATA 2000), permitting
qualified physicians to prescribe narcotic medications
(Schedules III to V) for the treatment of opioid addiction. This
legislation created a major paradigm shift by allowing access to
opiate treatment in a medical setting rather than limiting it to
specialized drug treatment clinics. To date, nearly 10,000
physicians have taken the training needed to prescribe these two
medications, and nearly 7,000 have registered as potential
providers.
Behavioral Treatments
help patients engage in the treatment process, modify their
attitudes and behaviors related to drug abuse, and increase
healthy life skills. Behavioral treatments can also enhance the
effectiveness of medications and help people stay in treatment
longer.
Outpatient behavioral treatment
encompasses a wide variety of programs for patients who visit a
clinic at regular intervals. Most of the programs involve
individual or group drug counseling. Some programs also offer
other forms of behavioral treatment such as:
- Cognitive Behavioral Therapy, which seeks to help
patients recognize, avoid, and cope with the situations in
which they are most likely to abuse drugs.
- Multidimensional Family Therapy, which addresses a range
of influences on the drug abuse patterns of adolescents and
is designed for them and their families.
- Motivational Interviewing, which capitalizes on the
readiness of individuals to change their behavior and enter
treatment.
- Motivational Incentives (contingency management), which
uses positive reinforcement to encourage abstinence from
drugs.
Residential treatment programs can
also be very effective, especially for those with more severe
problems. For example, therapeutic communities (TCs) are highly
structured programs in which patients remain at a residence,
typically for 6 to 12 months. Patients in TCs may include those
with relatively long histories of drug addiction, involvement in
serious criminal activities, and seriously impaired social
functioning. TCs are now also being designed to accommodate the
needs of women who are pregnant or have children. The focus of
the TC is on the re-socialization of the patient to a drug-free,
crime-free lifestyle.
Treatment Within the Criminal Justice System can succeed in preventing an offender's return to criminal behavior, particularly when treatment continues as the person transitions back into the community. Studies show that treatment does not need to be voluntary to be effective. Research suggests that treatment can cut drug abuse in half, drastically decrease criminal activity, and significantly reduce arrests
If you or a loved one need help immediately, please do call us as soon as possible. We are always on call and willing to help if given the opportunity. Please call The Awakening at 1-877-888-9858 .
