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Principles of
Effective Treatment
- No single
treatment is appropriate for all individuals. Matching treatment
settings, interventions, and services to each individual's particular
problems and needs is critical to his or her ultimate success in
returning to productive functioning in the family, workplace, and
society.
- Treatment
needs to be readily available. Because individuals who are addicted
to drugs may be uncertain about entering treatment, taking advantage
of opportunities when they are ready for treatment is crucial. Potential
treatment applicants can be lost if treatment is not immediately
available or is not readily accessible.
- Effective
treatment attends to multiple needs of the individual, not just
his or her drug use. To be effective, treatment must address
the individual's drug use and any associated medical, psychological,
social, vocational, and legal problems.
- An individual's
treatment and services plan must be assessed continually and modified
as necessary to ensure that the plan meets the person's changing
needs. A patient may require varying combinations of services
and treatment components during the course of treatment and recovery.
In addition to counseling or psychotherapy, a patient at times may
require medication, other medical services, family therapy, parenting
instruction, vocational rehabilitation, and social and legal services.
It is critical that the treatment approach be appropriate to the
individual's age, gender, ethnicity, and culture.
- Remaining
in treatment for an adequate period of time is critical for treatment
effectiveness. The appropriate duration for an individual depends
on his or her problems and needs (see pages 11-49). Research indicates
that for most patients, the threshold of significant improvement
is reached at about 3 months in treatment. After this threshold
is reached, additional treatment can produce further progress toward
recovery. Because people often leave treatment prematurely, programs
should include strategies to engage and keep patients in treatment.
- Counseling
(individual and/or group) and other behavioral therapies are critical
components of effective treatment for addiction. In therapy,
patients address issues of 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
and the individual's ability to function in the family and community.
(Approaches
to Drug Addiction Treatment section discusses details of different
treatment components to accomplish these goals.)
- Medications
are an important element of treatment for many patients, especially
when combined with counseling and other behavioral therapies.
Methadone and levo-alpha-acetylmethadol (LAAM) are very effective
in helping individuals addicted to heroin or other opiates stabilize
their lives and reduce their illicit drug use. Naltrexone is also
an effective medication for some opiate addicts and some patients
with co-occurring alcohol dependence. For persons addicted to nicotine,
a nicotine replacement product (such as patches or gum) or an oral
medication (such as bupropion) can be an effective component of
treatment. For patients with mental disorders, both behavioral treatments
and medications can be critically important.
- Addicted
or drug-abusing individuals with coexisting mental disorders should
have both disorders treated in an integrated way. Because addictive
disorders and mental disorders often occur in the same individual,
patients presenting for either condition should be assessed and
treated for the co-occurrence of the other type of disorder.
- Medical
detoxification is only the first stage of addiction treatment and
by itself does little to change long-term drug use. Medical
detoxification safely manages the acute physical symptoms of withdrawal
associated with stopping drug use. While detoxification alone is
rarely sufficient to help addicts achieve long-term abstinence,
for some individuals it is a strongly indicated precursor to effective
drug addiction treatment (see Drug Addiction
Treatment Section).
- Treatment
does not need to be voluntary to be effective. Strong motivation
can facilitate the treatment process. Sanctions or enticements in
the family, employment setting, or criminal justice system can increase
significantly both treatment entry and retention rates and the success
of drug treatment interventions.
- Possible
drug use during treatment must be monitored continuously. Lapses
to drug use can occur during treatment. The objective monitoring
of a patient's drug and alcohol use during treatment, such as through
urinalysis or other tests, can help the patient withstand urges
to use drugs. Such monitoring also can provide early evidence of
drug use so that the individual's treatment plan can be adjusted.
Feedback to patients who test positive for illicit drug use is an
important element of monitoring.
- 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 themselves or
others at risk of infection. Counseling can help patients avoid
high-risk behavior. Counseling also can help people who are already
infected manage their illness.
- 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. Addicted individuals may require prolonged treatment and
multiple episodes of treatment to achieve long-term abstinence and
fully restored functioning. Participation in self-help support programs
during and following treatment often is helpful in maintaining abstinence.
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