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TREATMENT
Information obtained in its entirety from the National Institute
on Drug Abuse (NIDA) web site; http://www.nida.nih.gov/.
DRUG
ADDICTION
Drug addiction is a complex illness characterized by intense
and, at times, uncontrollable drug craving, along with compulsive
drug seeking and use that persist even in the face of devastating
consequences. While the path to alcohol and drug t begins
with the voluntary act of taking alcohol and drugs, over
time a person's ability to choose not to do so becomes compromised,
and seeking and consuming the alcohol and drug becomes compulsive.
This behavior results largely from the effects of prolonged
alcohol and drug exposure on brain functioning. Addiction
is a brain disease that affects multiple brain circuits,
including those involved in reward and motivation, learning
and memory, and inhibitory control over behavior.
Because alcohol and drug abuse addiction have so many dimensions
and disrupt so many aspects of an individual's life, treatment
is not simple. Effective alcohol and drug treatment programs
typically incorporate many components, each directed to
a particular aspect of the illness and its consequences.
Alcohol and drug treatment (drug Rehab) must help the individual
stop using drugs, maintain a drug-free lifestyle, and achieve
productive functioning in the family, at work, and in society.
Because addiction is typically a chronic disease, people
cannot simply stop using alcohol and drugs for a few days
and be cured. Most patients require long-term or repeated
episodes of care to achieve the ultimate goal of sustained
abstinence and recovery of their lives. |
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Too often alcohol
and drug addiction goes untreated: According to SAMHSA's National
Survey on Drug Use and Health (NSDUH), 23.2 million persons
(9.4 percent of the U.S. population) aged 12 or older needed
alcohol and drug treatment (Drug Rehab) for an illicit drug
or alcohol use problem in 2007. Of these individuals, 2.4 million
(10.4 percent of those who needed Alcohol and drug treatment)
(drug Rehab) received treatment at a specialty facility (i.e.,
hospital, drug or alcohol Rehab or mental health center). Thus,
20.8 million persons (8.4 percent of the population aged 12
or older) needed alcohol and drug treatment (drug Rehab) for
an illicit drug or alcohol use problem but did not receive it.
These estimates are similar to those in previous years.
Principles of Effective alcohol and Drug Treatment (Drug
Rehab)
Scientific research since the mid–1970s shows that drug
treatment (drug rehab) can help patients addicted to drugs stop
using, avoid relapse, and successfully recover their lives.
Based on this research, key principles have emerged that should
form the basis of any effective alcohol and drug treatment programs:
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Addiction
is a complex but treatable disease that affects brain function
and behavior.
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No
single alcohol and drug treatment (drug rehab) is appropriate
for everyone.
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Treatment
needs to be readily available.
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Effective
alcohol and drug treatment (drug rehab) attends to multiple
needs of the individual, not just his or her drug abuse.
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Remaining
in alcohol anddrug treatment (drug rehab) for an adequate
period of time is critical.
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Counseling—individual
and/or group—and other behavioral therapies are the most
commonly used forms of alcohol and drug treatment (drug rehab).
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Medications
are an important element of treatment for many patients, especially
when combined with counseling and other behavioral therapies.
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An
individual's alcohol and drug treatment and services plan
must be assessed continually and modified as necessary to
ensure that it meets his or her changing needs.
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Many
drug–addicted individuals also have other mental disorders.
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Medically
assisted detoxification is only the first stage of alcohol
and drug addiction treatment (drug rehab) and by itself does
little to change long–term drug abuse.
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Alcohol
and Drug treatment (drug rehab) does not need to be voluntary
to be effective.
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Drug
use during treatment (drug rehab) must be monitored continuously,
as lapses during treatment do occur.
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Drug
Treatment programs should assess patients for the presence
of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious
diseases as well as provide targeted risk–reduction counseling
to help patients modify or change behaviors that place them
at risk of contracting or spreading infectious diseases.
Effective
Treatment Approaches
Medication and behavioral
therapy, especially when combined, are important elements 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 Alcohol and drug
treatment (drug rehab); preventing relapse is necessary for
maintaining its effects. And sometimes, as with other chronic
conditions, episodes of relapse may require a return to prior
alcohol and drug 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 follow–up 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
Medications can
be used to help with different aspects of the drug treatment
(drug rehab) process.
Withdrawal.
Medications offer help in suppressing withdrawal symptoms during
detoxification. However, medically assisted detoxification is
not in itself Drug"treatment"—it is only the
first step in the alcohol and drug treatment process. Patients
who go through medically assisted withdrawal but do not receive
any further alcohol and drug treatment (drug rehab) show drug
abuse patterns similar to those who were never treated.
Treatment.
Medications can be used to help reestablish normal brain function
and to prevent relapse and diminish cravings. Currently, we
have medications for (heroin, morph opioidsine), tobacco (nicotine),
and alcohol addiction and are developing others for treating
stimulant (cocaine, methamphetamine) and cannabis (marijuana)
addiction. Most people with severe addiction problems, however,
are polydrug users (users of more than one drug) and will require
treatment for all of the substances that they abuse.
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Opioids:
Methadone, buprenorphine and, for some individuals, naltrexone
are effective medications for the drug treatment (drug rehab)
of opiate addiction. Acting on the same targets in the brain
as heroin and morphine, methadone and buprenorphine suppress
withdrawal symptoms and relieve cravings. Naltrexone works
by blocking the effects of heroin or other opioids at their
receptor sites and should only be used in patients who have
already been detoxified. Because of compliance issues, naltrexone
is not as widely used as the other medications. All medications
help patients disengage from drug seeking and related criminal
behavior and become more receptive to behavioral treatments.
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Alcohol:
Three medications have been FDA–approved for treating
alcohol dependence: naltrexone, acamprosate, and disulfiram.
A fourth, topiramate, is showing encouraging results in clinical
trials. Naltrexone blocks opioid receptors that are involved
in the rewarding effects of drinking and in the craving for
alcohol. It reduces relapse to heavy drinking and is highly
effective in some but not all patients—this is likely
related to genetic differences. Acamprosate is thought to
reduce symptoms of protracted withdrawal, such as insomnia,
anxiety, restlessness, and dysphoria (an unpleasant or uncomfortable
emotional state, such as depression, anxiety, or irritability).
It may be more effective in patients with severe dependence.
Disulfiram interferes with the degradation of alcohol, resulting
in the accumulation of acetaldehyde, which, in turn, produces
a very unpleasant reaction that includes flushing, nausea,
and palpitations if the patient drinks alcohol. Compliance
can be a problem, but among patients who are highly motivated,
disulfiram can be very effective.
Behavioral Treatments
Behavioral treatments
help patients engage in the drug treatment (drug rehab) process,
modify their attitudes and behaviors related to drug abuse,
and increase healthy life skills. These treatments can also
enhance the effectiveness of medications and help people stay
in drug treatment (drug rehab) longer. Treatment for drug abuse
and addiction can be delivered in many different settings using
a variety of behavioral approaches.
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—
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Cognitive–behavioral
therapy, which seeks to help patients recognize, avoid, and
cope with the situations in which they are most likely to
abuse drugs.
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Multidimensional
family therapy, which was developed for adolescents with drug
abuse problems—as well as their families—addresses
a range of influences on their drug abuse patterns and is
designed to improve overall family functioning.
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Motivational
interviewing, which capitalizes on the readiness of individuals
to change their behavior and enter drug treatment (drug rehab).
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Motivational
incentives (contingency management), which uses positive reinforcement
to encourage abstinence from drugs.
Residential
drug treatment programs (drug Rehab) 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. TCs differ
from other treatment approaches principally in their use of the
community alcohol and Drug Rehab staff and those in recovery—as
a key agent of change to influence patient attitudes, perceptions,
and behaviors associated with drug use. 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 reconciliation of the patient to a drug-free,
crime–free lifestyle.
Criminal Justice Drug Treatment
Alcohol and drug
treatment (drug rehab) in a criminal justice setting 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 drug treatment (drug rehab)
does not need to be voluntary to be effective.
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/PODAT_CJ.
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