Principles of Effective Drug Addiction Treatment
Excerpted
from the National Institutes of Health (NIH)'s Research-based Publication
No. 99-4180; printed October 1999.
Drug addiction is a
complex illness. It is characterized by compulsive, at times
uncontrollable, drug craving, seeking, and use that persists even in the
face of extremely negative consequences. Drug seeking becomes compulsive,
in large part as a result of the effects of prolonged drug use on brain
functioning and, thus, on behavior. Because addiction has so many
dimensions and disrupts so many aspects of an individual's life, treatment
for this illness is never simple. Effective treatment programs typically
incorporate many components, each directed to a particular aspect of the
illness and its consequences. Not all drug abuse treatment is equally
effective. Research has revealed a set of overarching principles that
characterize the most effective drug abuse and addiction treatments and
their implementation. The following summarizes the overarching principles
that characterize effective treatment: 1. No single treatment is
appropriate for all individuals. Matching treatment settings,
interventions, and services to each person's particular problems is
critical to his or her ultimate success in returning to productive
functioning in the family, workplace, and society.2. 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
accessible. 3. Effective treatment attends to multiple needs of the
individual, not just his or her drug use. Treatment must address drug
use and any associated medical, psychological, social, vocational, and
legal problems. 4. 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. It is also critical that the treatment approach be appropriate
to the individual's age, gender, ethnicity, and culture. 5. Remaining in treatment
for an adequate period of time is critical for treatment effectiveness.
Research indicates that for most patients, the threshold of
significant improvement is reached in about three months of treatment.
6. Counseling
(individual 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 non-drug-using
activities, and improve problem-solving abilities. Behavioral therapy also
faciltates interpersonal relations and the individual's ability to
function in the family and community. 7. Medications are an
important element of treatment for many patients, especially when combined
with counseling and other behavioral therapies. For patients with
mental disorders, both behavioral treatments and medications can be
critically important. 8. Addicted or drug-abusing
individuals with coexisting mental disorders should have both disorders
treated in an integrated way. Patients presenting either condition
should be assessed and treated for the co-occurrence of the other type of
disorder.
9. Medical
detoxification is only the first stage of addiction treatment and by
itself does little to change long-term drug use. Medication
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. 10.
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
significantly increase both treatment entry and retention rates and the
success of drug treatment interventions. 11. 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 can also provide
early evidence of drug use so the individual's treatment plan can be
adjusted. Feedback to patients who test positive for illicit drug use is
an important element of monitoring. 12. 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 can also
help people who are already infected manage their illness. 13. 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. According to several studies,
drug treatment reduces drug use by 40-60 percent and significantly
decreases criminal activity during and after treatment. However,
individual treatment outcomes depend on the extent and nature of the
patient's presenting problems, the appropriateness of the treatment
components and related services used to address those problems, and the
degree of the patient's active engagement in the treatment
process.