April, 22 2018
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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
- 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. 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.
- 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
- 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.
- 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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