Drug Addiction Treatment
in the United States
- Short-Term Residential Programs provide intensive but relatively
brief residential treatment based on a modified 12-step approach.
These programs were originally designed to treat alcohol problems,
but during the cocaine epidemic of the mid-1980's, many began to treat
illicit drug abuse and addiction. The original residential treatment
model consisted of a 3 to 6 week hospital-based inpatient treatment
phase followed by extended outpatient therapy and participation in
a self-help group, such as Alcoholics Anonymous. Reduced health care
coverage for substance abuse treatment has resulted in a diminished
number of these programs, and the average length of stay under managed
care review is much shorter than in early programs.
Further Reading:
Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; Anderson, J.; and Etheridge,
R.M. Overview of 1-year follow-up outcomes in the Drug Abuse Treatment
Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4):
291-298, 1998.
Miller, M.M. Traditional approaches to the treatment of addiction.
In: Graham A.W. and Schultz T.K., eds. Principles of Addiction
Medicine, 2nd ed. Washington, D.C.: American Society of Addiction
Medicine, 1998.
- Medical Detoxification is a process whereby individuals are
systematically withdrawn from addicting drugs in an inpatient or outpatient
setting, typically under the care of a physician. Detoxification is
sometimes called a distinct treatment modality but is more appropriately
considered a precursor of treatment, because it is designed to treat
the acute physiological effects of stopping drug use. Medications
are available for detoxification from opiates, nicotine, benzodiazepines,
alcohol, barbiturates, and other sedatives. In some cases, particularly
for the last three types of drugs, detoxification may be a medical
necessity, and untreated withdrawal may be medically dangerous or
even fatal.
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Detoxification is a precursor of treatment.
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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.
Detoxification is most useful when it incorporates formal processes
of assessment and referral to subsequent drug addiction treatment.
Further Reading:
Kleber, H.D. Outpatient detoxification from opiates. Primary Psychiatry
1: 42-52, 1996.
Treating Criminal Justice-Involved Drug Abusers
and Addicts
Research has shown that combining criminal justice sanctions with drug
treatment can be effective in decreasing drug use and related crime.
Individuals under legal coercion tend to stay in treatment for a longer
period of time and do as well as or better than others not under legal
pressure. Often, drug abusers come into contact with the criminal justice
system earlier than other health or social systems, and intervention
by the criminal justice system to engage the individual in treatment
may help interrupt and shorten a career of drug use. Treatment for the
criminal justice-involved drug abuser or drug addict may be delivered
prior to, during, after, or in lieu of incarceration.
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Combining criminal justice sanctions
with drug treatment can be effective in decreasing drug use
and related crime.
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- Prison-Based Treatment Programs
Offenders with drug disorders may encounter a number of treatment
options while incarcerated, including didactic drug education classes,
self-help programs, and treatment based on therapeutic community
or residential milieu therapy models. The TC model has been studied
extensively and can be quite effective in reducing drug use and
recidivism to criminal behavior. Those in treatment should be segregated
from the general prison population, so that the "prison culture"
does not overwhelm progress toward recovery. As might be expected,
treatment gains can be lost if inmates are returned to the general
prison population after treatment. Research shows that relapse to
drug use and recidivism to crime are significantly lower if the
drug offender continues treatment after returning to the community.
- Community-Based Treatment for Criminal Justice Populations
A number of criminal justice alternatives to incarceration have
been tried with offenders who have drug disorders, including limited
diversion programs, pretrial release conditional on entry into treatment,
and conditional probation with sanctions. The drug court is a promising
approach. Drug courts mandate and arrange for drug addiction treatment,
actively monitor progress in treatment, and arrange for other services
to drug-involved offenders. Federal support for planning, implementation,
and enhancement of drug courts is provided under the U.S. Department
of Justice Drug Courts Program Office.
As a well-studied example, the Treatment Accountability and Safer
Communities (TASC) program provides an alternative to incarceration
by addressing the multiple needs of drug-addicted offenders in a
community-based setting. TASC programs typically include counseling,
medical care, parenting instruction, family counseling, school and
job training, and legal and employment services. The key features
of TASC include (1) coordination of criminal justice and drug treatment;
(2) early identification, assessment, and referral of drug-involved
offenders; (3) monitoring offenders through drug testing; and (4)
use of legal sanctions as inducements to remain in treatment.
Further Reading:
Anglin, M.D. and Hser, Y. Treatment of drug abuse. In: Tonry M.
and Wilson J.Q., eds. Drugs and crime. Chicago: University of Chicago
Press, 1990, pp. 393-460.
Hiller, M.L.; Knight, K.; Broome, K.M.; and Simpson, D.D. Compulsory
community-based substance abuse treatment and the mentally ill criminal
offender. The Prison Journal 76(2), 180-191, 1996.
Hubbard, R.L.; Collins, J.J.; Rachal, J.V.; and Cavanaugh, E.R.
The criminal justice client in drug abuse treatment. In Leukefeld
C.G. and Tims F.M., eds. Compulsory treatment of drug abuse: Research
and clinical practice [NIDA Research Monograph 86]. Washington,
DC: U.S. Government Printing Office, 1998.
Inciardi, J.A.; Martin, S.S.; Butzin, C.A.; Hooper, R.M.; and Harrison,
L.D. An effective model of prison-based treatment for drug-involved
offenders. Journal of Drug Issues 27 (2): 261-278, 1997.
Wexler, H.K. The success of therapeutic communities for substance
abusers in American prisons. Journal of Psychoactive Drugs 27(1):
57-66, 1997.
Wexler, H.K. Therapeutic communities in American prisons. In Cullen,
E.; Jones, L.; and Woodward R., eds. Therapeutic Communities in
American Prisons. New York: Wiley and Sons, 1997.
Wexler, H.K.; Falkin, G.P.; and Lipton, D.S. (1990). Outcome evaluation
of a prison therapeutic community for substance abuse treatment.
Criminal Justice and Behavior 17(1): 71-92, 1990.
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