|
The American Society
of Addiction Medicine (ASAM) defines drug addiction treatment
as an application of planned procedures to identify and change patterns
of behavior that are maladaptive, destructive, and/or injurious to
health; or to restore appropriate levels of physical, psychological,
and/or social functioning. Drug addiction treatment can include behavioral
modification, medications, or their combination.
What are the basic goals of treatment?
Maximizing motivation for abstinence. Abstinence is accepted
as the only clinically relevant goal for drug addiction programs.
Rebuilding a drug-free lifestyle. Important elements in
developing a drug-free lifestyle include helping the individual discover
ways of dealing with free time, developing relationships with drug-free
friends, adjusting to the “mundane” aspects of day-to-day
living in the absence of the crisis-upon-crisis lifestyle associated
with drug use, and reestablishing rewarding relationships with family
members. These are all critical to successful recovery.
Maximizing physical and mental health. Patients will find
it difficult to achieve abstinence if chronic medical problems have
not been treated adequately.
What makes for good treatment?
The National Institute
on Drug Abuse (NIDA) identifies 12 principles for effective drug
addiction treatment. They are:
- No single treatment is appropriate for all individuals. This is
consistent with previous research that suggests that matching clients
to the most appropriate treatment setting, intervention, and services
is critical to treatment success.
- Treatment needs to be readily available.
- Effective treatment attends to multiple needs of the individual.
Not only should the client’s drug use be addressed, but also
his or her associated medical, social, psychological, vocational,
and legal problems.
- Remaining in treatment for an adequate period of time is critical
for treatment effectiveness. This is consistent with previous research
that suggests that the longer one is committed to treatment, the
greater the likelihood of positive outcomes.
- Individual and/or group counseling and other behavioral therapies
are critical components of effective treatment.
- Medications are often an important element of treatment. Methadone,
for example, helps persons addicted to opiates stabilize their lives
and reduce their drug use.
- Addicted or drug-abusing individuals with coexisting mental disorders
should have both disorders treated in an integrated fashion.
- Medical detoxification is only the first stage of addiction treatment.
While it manages the acute physical symptoms of withdrawal, it does
little to change long-term drug use.
- Treatment does not need to be voluntary to be effective. Sanctions
or enticements in the family, employment, or criminal justice setting
can significantly increase treatment entry, retention, and success.
- Possible drug use during treatment must be monitored continuously.
Monitoring through urinalysis, for example, can help patients withstand
the urge to use drugs and can provide early evidence of relapse.
- Treatment programs should provide assessment for sexually transmitted
diseases.
- Recovering from addiction is a long-term process.
What are the different kinds of treatment?
There is no one-size-fits-all treatment program. Ideally, treatment
should be tailored to the specific needs of individual members and
will vary by setting, duration, and intensity. While a number of different
treatment settings exist, all have been shown to be effective in reducing
drug use. There are two general types of treatment, under which a
variety of specific approaches exist. They are residential/inpatient
and outpatient programs.
Residential or Inpatient refers to a variety of treatments
that take place in one of a number of different settings. The treatment
may take place either in a medical or general psychiatric setting
or in a specialized chemical dependency unit. Inpatient treatment
offers several advantages over less intensive programs.
- Hospital settings offer a high level of medical supervision for
individuals who require intensive physical and/or psychiatric monitoring.
- The intensity of inpatient treatment may be helpful to patients
who do not respond to lesser measures. For example, hospital treatment
may benefit those who are too discouraged or unmotivated to attend
outpatient treatment meetings regularly.
- Inpatient treatment may benefit some individuals by increasing
their awareness of the internal triggers that place them at risk
to return to drug abuse.
- Inpatient treatment can help to interrupt a cycle of drug use
even in the absence of dangerous withdrawal symptoms.
Therapeutic communities (TCs), for example, are a special type of
inpatient program. TCs are highly structured programs in which patients
stay at a residence, typically for 6 to 12 months. Patients in TCs
include those with relatively long histories of drug dependence, involvement
in serious criminal activities, and seriously impaired social functioning.
The TC views drug abuse as a deviant behavior. Thus, the principal
aim of the TC is a global change in lifestyle: abstinence, elimination
of antisocial behavior, and the development of employability and pro-social
attitudes and values.
Outpatient programs use approaches that permit the rehabilitation
of the addict in their real-life settings. Such treatment costs less
than inpatient treatment and often is more suitable for individuals
who are employed or who have extensive social supports. Low-intensity
programs may offer little more than drug education and admonition.
Other outpatient models, such as intensive day treatment, can be comparable
to residential programs in services and effectiveness, depending on
the individual patient’s characteristics and needs. In many
outpatient programs, group counseling is emphasized.
Within both the inpatient and outpatient systems, several methods
of treatment exist:
Network therapy – An approach to rehabilitation in
which specific family members and friends are enlisted to provide
ongoing support and to promote attitude and behavioral changes. Network
members are part of the therapist’s working “team”
and not subjects of treatment themselves.
Detoxification – The process whereby individuals are
withdrawn from drugs in an inpatient or outpatient setting, typically
under the care of a physician. Detoxification is not designed to address
the psychological, social, and behavioral problems associated with
addiction and therefore does not typically produce lasting behavioral
changes necessary for recovery.
Group therapy – Traditionally the most popular approach
to the problem of addiction. Group approaches include, for example,
Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). What all group
approaches share is an appreciation of the healing power of the connection
with others.
Relapse prevention – A cognitive behavioral program
that consists of a collection of strategies intended to enhance self-control.
Specific techniques include exploring the positive and negative consequences
of continued use, self-monitoring to recognize drug cravings early
on and to identify high-risk situations for use, and developing strategies
for coping with and avoiding high-risk situations and the desire to
use.
Education – In addition to the drug-related physical
and psychological issues that must be addressed during treatment,
individuals typically need to be trained for life beyond drug use.
This will often involve pursuing a high school diploma or GED or taking
college-level courses. Research has shown a positive correlation between
education and a drug-free lifestyle after treatment.
Life skills – As with education, individuals need
to be retrained on basic life skills. Treatment programs will often
incorporate lessons on personal hygiene, opening a bank account, going
food shopping, and keeping a clean house into their treatment regimen.
Workforce development – Treatment programs realize
that recovering drug abusers will need to either return to their place
of work or find new employment. While workforce development is easier
for individuals with certain skills, recovering addicts often need
to start fresh. A critical component of drug treatment is providing
the necessary skills so that employment can be obtained after treatment
is completed.
Are medications available for treatment?
Yes. Medications, like methadone, are available for people addicted
to opiates. Methadone treatment has been evaluated more rigorously
than any other drug abuse treatment alternative and has been shown
to be highly effective in retaining a large proportion of patients
by reducing their intravenous drug use, HIV rates, and criminal activity,
and by enhancing their social productivity. The most effective maintenance
programs provide methadone as well as other medical, behavioral, and
social services.
Medications and behavioral therapies are available for other addictions
as well. Nicotine preparations (patches, gum, and nasal spray) are
available for individuals addicted to nicotine. Naltrexone is available
to help reduce the risk of relapse to heavy drinking, while Antabuse
causes nausea and vomiting if consumed with alcohol.
What is relapse?
Relapse is the recurrence of psychoactive drug-dependent behavior
in an individual who has previously achieved and maintained abstinence
for a significant period of time beyond withdrawal. Relapse is not
an isolated event, but a process whereby an individual becomes unable
to cope with life in sobriety and thus can no longer avoid using alcohol
or other drugs.
The process is marked by predictable and identifiable warning signs
that begin well before the return to use. One particular warning in
early recovery occurs when an addict begins to seek out situations
involving people who use alcohol or other drugs. In order to prevent
relapse, the client may have to continue addressing these issues for
years after leaving treatment.
What steps can be taken to prevent or diminish
the harm of relapse?
The same support systems that are necessary to propel an individual
into treatment, such as friends and family members, are also necessary
when facing actual or potential relapse. Family and friends should
understand that relapses are part of the recovery process, and that
a relapse does not necessarily mean that a specific type of treatment
has not been, or will not be, successful. They should continue to
support the individual as if the relapse had not occurred, but realize
that additional support may also be necessary.
Drug testing is also a viable monitoring system. If individuals know
that their drug-using behaviors will be monitored by an objective
measure of drug use, and that any such drug use would have serious
consequences (e.g., incarceration or termination from treatment),
they might be able to withstand the pressures of potential relapse.
Does the use of medications like methadone
simply replace one drug addiction for another?
No. Methadone is not a heroin substitute. It is a safe and effective
medication for opiate addiction.
What are the best treatment programs?
The best treatment programs are comprehensive and multidimensional.
That is, the most effective programs are closely linked with a wide
variety of treatment alternatives and support services. Because recovery
is often a long and complex process, treatment providers must be able
to adjust treatment to ensure that it is appropriate to the individual’s
changing needs. In addition to behavioral and/or medical alternatives,
the patient may need parenting instruction, vocational rehabilitation,
and social and legal services.
Is drug treatment effective?
Research conducted within a variety of disciplines (e.g., criminology,
health, psychology, and psychiatry) suggests that treatment is effective
when clients are appropriately matched to services. It is critical,
therefore, that the needs of the drug user be evaluated prior to treatment
admission. Treatment success can be measured through a variety of
measures, including, for example, drug abstinence, general well being,
and sustained employment.
Overall, treatment of addiction is as successful as treatment of
other chronic diseases, such as diabetes, hypertension, and asthma.
Drug treatment reduces drug use by 40-60% and significantly decreases
criminal activity during and after treatment. Research shows that
drug addiction treatment reduces the risk of HIV infection and that
interventions to prevent HIV are much less costly than treating HIV-related
illnesses. Injection drug users who do not enter treatment are up
to six times more likely to become infected with HIV than injection
drug users who enter and remain in treatment. Treatment can improve
prospects for employment, with gains of up to 40% after a single treatment
stay. Although these effectiveness rates hold in general, individual
treatment outcomes depend on the extent and nature of the client’s
issues, the appropriateness of the treatment services utilized to
address those issues, and the degree to which the patient is actively
engaged in the treatment process.
How long does drug addiction treatment
usually last?
Individuals progress through drug addiction treatment at various
speeds. Nevertheless, research by the Center
for Substance Abuse Treatment (CSAT) has shown that length of
stay is positively related to treatment outcomes and that increasing
lengths of stay improve treatment outcomes. The average number of
days in methadone maintenance treatment is 302 days; 127 days for
non-methadone outpatient treatment; 110 days for long-term residential
treatment; and 50 for short-term residential treatment.
How do people find out about treatment
options?
Finding the treatment individual clients need can be challenging,
for a variety of reasons, including a lack of adequate treatment capacity.
Organizations that can help locate local programs include:
- State alcohol and drug treatment provider associations
- State alcohol and drug abuse agencies
- State chapters of the American Society of Addiction Medicine
(ASAM)
- State chapters of the national Association of Alcoholism and
Drug Abuse Counselors
- Employee Assistance Programs (EAPs)
Does treatment have to be voluntary?
No. Treatment does not have to be voluntary to be effective. Strong
motivations, such as sanctions or enticements in the family or workplace,
can help facilitate entry and sustain treatment. Nevertheless, it
is also true that for any treatment to be successful, the addict must
become an active and compliant participant in the regimen.
What are the costs of treatment?
The Center
for Substance Abuse Treatment (CSAT) identified the costs of client
drug abuse treatment for each treatment option. The average cost of
a single treatment effort is $2,941, ranging from a low of $2,051
for outpatient non-methadone treatment to $4,160 for short-term hospital
treatment.
How can the costs of treatment be covered?
The following are potential funding sources for drug treatment:
Medicaid – Depending on the type of treatment, Medicaid
may be a potential funding option. Consult your state agency for specific
information.
Private insurance – Private insurance companies will
often cover certain types of alcohol or other drug abuse treatment.
Consult your benefits provider for specific details.
Temporary Assistance for Needy Families (TANF) – Federal
TANF funds may be used for non-medical alcohol and drug treatment.
Welfare-to-Work (WtW) – Aimed at funding services
for the hardest-to-employ TANF recipients, including those “requiring
drug abuse treatment for employment” and non-custodial parents
of TANF children. Alcohol and drug treatment can be funded through
WtW as “job retention and supportive services,” as long
as they are not medical services.
Who are the people who need treatment and
are unable to receive it?
One study found that 47 percent of men and 41 percent of women in
need of treatment for illicit drug abuse are not treated. This inability
to obtain treatment often stems for inadequate education and the inability
to fund treat that is available.
|
