Drug addiction is a complex but treatable disease. It is
characterized by compulsive drug craving, seeking, and use that persist
even in the face of severe adverse consequences. For many people, drug
abuse becomes chronic, with relapses possible even after long periods
of abstinence. In fact, relapse to drug abuse occurs at rates similar
to those for other well-characterized, chronic medical illnesses such
as diabetes, hypertension, and asthma. As a chronic, recurring illness,
addiction may require repeated episodes of treatment before sustained
abstinence is achieved. Through treatment tailored to individual needs,
people with drug addiction can recover and lead productive lives.
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 followup
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.4
Other information sources
For
more detailed information on treatment approaches for drug addiction
and examples of specific programs proven effective through research,
view NIDA’s Principles of Drug Addiction Treatment: A Research-Based
Guide at www.nida.nih.gov/PODAT/PODATIndex.html (English) or www.nida.nih.gov/PODAT/Spanish/PODATIndex.html (Spanish).
For
information about treatment for drug abusers in the criminal justice
system, view NIDA’s Principles of Drug Abuse Treatment for Criminal
Justice Populations: A Research-Based Guide at www.drugabuse.gov/DrugPages/cj.html.
*Data
are from the National Survey on Drug Use and Health (formerly known as
the National Household Survey on Drug Abuse), which is an annual survey
of Americans age 12 and older conducted by the Substance Abuse and
Mental Health Services Administration. This survey is available online
at www.samhsa.gov and from the National Clearinghouse for Alcohol and Drug Information at 800-729-6686.
1
Office of National Drug Control Policy. The Economic Costs of Drug
Abuse in the United States: 1992–2002. Washington, DC: Executive Office
of the President (Publication No. 207303), 2004.
2 Harwood, H.
Updating Estimates of the Economic Costs of Alcohol Abuse in the United
States: Estimates, Update Methods, and Data Report. Prepared by the
Lewin Group for the National Institute on Alcohol Abuse and Alcoholism,
2000.
3 Centers for Disease Control and Prevention. Annual
Smoking–Attributable Mortality, Years of Potential Life Lost, and
Productivity Losses — United States, 1997–2001. Morbidity and Mortality
Weekly Report 54(25):625–628, July 1, 2005.
4 The National
Treatment Improvement Evaluation Study (NTIES): Highlights. DHHS
Publication No. (SMA) 97-3159. Rockville, MD: U.S. Department of Health
and Human Services, Substance Abuse and Mental Health Services
Administration, Center for Substance Abuse Treatment, Office of
Evaluation, Scientific Analysis and Synthesis, pp. 241–242. 1997.
Source: National Institute of Drug Abuse
Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates of New England
www.psychopharmassociates.com
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.
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.