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Substance addiction treatment information.

Decades of scientific research and clinical practice have yielded treatments for substance abuse and addiction that are as effective as treatments for chronic physical ailments. But not all addiction treatments are equally effective, and because addiction is a chronic disorder, long-term abstinence often requires sustained and repeated treatment episodes.

In 1999, the National Institute on Drug Abuse (NIDA) released Principles of Drug Addiction Treatment: A Research Based Guide, which identified a set of 13 overarching principles that characterize the most effective drug abuse and addiction treatments and their implementation.

1. 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.

2. 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.

3. 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.

4. 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.

5. 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 three 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.

6. 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 non-drug-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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

Principles of Drug Addiction Treatment is just one of dozens of publications, fact sheets, and other materials available free on NIDA's Web site, Other sources of addiction treatment information include the following:

* The National Institute on Alcohol Abuse and Alcoholism ( publishes a quarterly newsletter, Alcohol Alert, sponsors clinical trials and research projects, hosts conferences and meetings, and provides referrals to several other organizations and Web sites.

* The Substance Abuse and Mental Health Services Administration ( operates the Substance Abuse Treatment Facility Locator, a searchable directory of licensed, certified, and otherwise approved federal, state, local, and private treatment facilities. The locator includes more than 11,000 addiction treatment programs, including residential treatment centers, outpatient treatment programs, and hospital inpatient programs for drug addiction and alcoholism. Listings include treatment programs for marijuana, cocaine, and heroin addiction as well as drug and alcohol treatment programs for adolescents and adults.

* The National Drug and Alcohol Treatment Referral Routing Service provides a toll-free telephone number, 1-800-662-HELP. Through this service you can speak directly to a representative concerning substance abuse treatment, request printed material on alcohol or other drugs, or obtain local substance abuse treatment referral information in your state.

* The National Council on Alcoholism and Drug Dependence maintains a Web site ( and toll-free telephone number (1-800-622-2255) that list local information and referral services.

* Demand Treatment provides grants to community-based projects that feature innovative methods to increase demand for quality alcohol and drug abuse treatment. Demand Treatment is an initiative of Join Together (, a project that seeks to reduce substance abuse and gun violence.

* Alcoholics Anonymous, a self- and mutual-help program founded in 1935, publishes Alcoholics Anonymous (also known as the "Big Book"). Now in its fourth printing, Alcoholics Anonymous contains 42 stories of personal recovery and lists the Twelve Steps that form the basis of recovery from alcohol addiction. Copies of Alcoholics Anonymous and information about the Twelve Steps are available from local AA services offices.

In addition to these resources, information is available from addiction treatment facilities and programs in local communities and from public health or substance abuse agencies.
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Title Annotation:Resource Spotlight
Publication:The Journal of Employee Assistance
Geographic Code:1USA
Date:Jun 1, 2003
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