More than three decades of scientific research have yielded 13
fundamental principles that characterize effective drug abuse
treatment. These principles are detailed in NIDA's Principles of Drug Addiction Treatment: A Research-Based Guide.
1. No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each patient's problems and needs is critical.
2. Treatment needs to be readily available. Treatment applicants can be lost if treatment is not immediately available or readily accessible.
3. 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.
4.
At different times during treatment, a patient may develop a need for
medical services, family therapy, vocational rehabilitation, and social
and legal services.
5. 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.
6. 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 nondrug-using activities, and improve problem-solving
abilities. Behavioral therapy also facilitates interpersonal
relationships.
7.
Medications are an important element of treatment for many patients,
especially when combined with counseling and other behavioral therapies.
Buprenorphine, methadone and levo-alpha-acetylmethodol (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 buproprion, can help persons addicted to
nicotine.
8. Addicted or drug-abusing individuals with
coexisting mental disorders should have both disorders treated in an
integrated way.
9. 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.
10. 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.
11. 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.
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 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.
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. Participation in self-help
support programs during and following treatment often helps maintain
abstinence.
Source: National Institute of Drug Abuse
Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates of New England
www.psychopharmassociates.com
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