Drug addiction is a treatable disorder. Through treatment that is tailored to individual needs, patients can learn to control their condition and live normal, productive lives. Those in treatment for drug addiction, like people with diabetes or heart disease, learn behavioral changes and often take medications as part of their recovery program.
Behavioral therapies can include counseling, family therapy, psychotherapy or support groups. Treatment medications help to suppress withdrawal symptoms and drug cravings and to block the effects of drugs. In addition, studies show that treatment for heroin addiction using methadone at an adequate dosage level combined with behavioral therapy reduces death rates and many health problems associated with heroin abuse.
Results tend to be better when more treatment is given. Many patients require other services as well, such as medical and mental health services and HIV prevention services. Patients who stay in treatment longer than three months usually have better outcomes than those who stay less time. Patients who go through medically assisted withdrawal without any further treatment perform about the same in terms of their drug use as those who were never treated. Studies over the last 25 years have shown that treatment reduces drug intake and crimes committed by drug-dependent people. Researchers also have found that drug abusers who have been through treatment are more likely to have jobs.
Medication
Methadone, a synthetic opioid that blocks the effects of heroin and other opioids, has been used for more than 30 years to eliminate withdrawal symptoms and relieve drug craving.
Other medications include LAAM (levo-alpha-acetyl-methadol), an alternative to methadone that blocks the effects of opioids for up to 72 hours. Naltrexone is a long acting opioid blocker often used with highly motivated individuals in treatment programs promoting complete abstinence, and also to prevent relapse.
Naloxone counteracts the effects of opioids and is used to treat overdoses.
Types of Treatment Programs
The ultimate goal of treatment is lasting abstinence, but the immediate goals are reduction of drug use, improvement of the patient's ability to function, and diminishing the medical and social complications of drug abuse.
There are several types of drug abuse treatment programs. Short-term methods last less than six months and include residential therapy, medication therapy and drug-free outpatient therapy. Longer-term treatment may include, for example, methadone maintenance outpatient treatment for opiate addicts and residential therapeutic community treatment.
In maintenance treatment for heroin addicts, patients are given an oral dose of a synthetic opiate, usually methadone hydrochloride or levo-alpha-acetyl methadol (LAAM), administered at a dosage sufficient to block the effects of heroin and yield a stable, noneuphoric state free from physiological craving for opiates. In this stable state, the patient is able to disengage from drug-seeking and related criminal behavior and, with appropriate counseling and social services, become a productive member of his or her community.
Outpatient drug-free treatment encompasses a wide variety of programs for patients who visit a clinic regularly. Most of the programs involve individual or group counseling. Patients entering these programs are abusers of drugs other than opiates or are opiate abusers for whom maintenance therapy is not recommended, such as those who lead well-integrated lives and have only brief histories of drug dependence.
Therapeutic communities (TCs) are highly structured programs in which patients stay at a residence, typically for 6 to 12 months, where the focus is on the resocialization of the patient to a crime-free, drug-free lifestyle. Patients in TCs include those with relatively long histories of drug dependence, involvement in serious criminal activities and seriously impaired social functioning.
Short-term residential programs, often referred to as chemical dependency units, are often based on the "Minnesota Model" of treatment for alcoholism. These programs involve a 3- to 6-week inpatient treatment phase followed by extended outpatient therapy or participation in 12-step self-help groups, such as Narcotics Anonymous or Cocaine Anonymous. Chemical dependency programs for drug abuse arose in the private sector in the mid-1980s with insured alcohol/cocaine abusers as their primary patients. Today, as private provider benefits decline, more programs are extending their services to publicly funded patients.
Methadone maintenance programs are usually more successful at retaining clients with opiate dependence than are therapeutic communities, which tend to have greater success than outpatient programs that provide psychotherapy and counseling. Within various methadone programs, those that provide higher doses of methadone (usually a minimum of 60 mg) have better retention rates. Those that provide other services, such as counseling and medical care, along with methadone, generally achieve better results than the programs that provide minimal services.
Drug treatment programs in prisons can succeed in preventing a return to criminal behavior, particularly if the patient is involved in a community-based program that continues treatment after he or she has left prison. Some of the more successful programs have reduced the re-arrest rate by one-fourth to one-half. For example, the "Delaware Model," an ongoing study of comprehensive treatment of drug-addicted prison inmates, shows that prison-based treatment including a therapeutic community setting, a work release therapeutic community\ and community-based aftercare reduces the probability of re-arrest by 57 percent and reduces the likelihood of returning to drug use by 37 percent.
Drug abuse has a high economic impact on society—an estimated $67 billion per year. This figure includes costs related to crime, medical care, treatment programs, social welfare programs and time lost from work. Treatment of drug abuse can reduce those costs. It costs approximately $3,600 per month to leave a drug abuser untreated, and incarceration costs approximately $3,300 per month. In contrast, methadone maintenance therapy costs about $290 per month. Overall, studies have shown that from $4 to $7 are saved for every dollar spent on treatment.
Opioids. Last reviewed 12/31/1969
Sources:
- National Cancer Institute National Institutes of Health
- U.S. Department of Health and Human Services National Institute on Drug Abuse
