"Thirteen Principles of
Effective Drug Addiction Treatment"
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More
than two decades of scientific research have yielded a set of fundamental
principles that characterize effective drug abuse treatment. These 13
principles, which are detailed in NIDA's new research-based guide, Principles of Drug Addiction
Treatment: A Research-based Guide, are:
1. " No single
treatment is appropriate for all individuals. Matching
treatment settings, interventions, and services to each patient's problems
and needs is critical.
2. Treatment needs to
be readily available. Treatment applicants can be lost if treatment is not
immediately available or readily accessible.
3. Effective
treatment attends to multiple needs of the individual, not just his or her
drug use. Treatment must address the individual's drug use and associated
medical, psychological, social, vocational, and legal problems.
4. Treatment needs to
be flexible
and to provide ongoing assessments of patient needs, which may change during
the course of treatment.
5. Remaining in
treatment for an adequate period of time is critical for treatment
effectiveness.
The time depends on an individual's needs. For most patients, the threshold
of significant improvement is reached at about 3 months in treatment.
Additional treatment can produce further progress. Programs should include
strategies to prevent patients from leaving treatment prematurely.
6. Individual and/or
group counseling and other behavioral therapies are critical components of
effective treatment for addiction. In therapy, patients address 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.
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) help persons addicted to opiates stabilize
their lives and reduce their drug use. Naltrexone is effective for some
opiate addicts and some patients with co-occurring alcohol dependence.
Nicotine patches or gum, or an oral medication, such as bupropion, can help
persons addicted to nicotine.
8. Addicted or
drug-abusing individuals with coexisting mental disorders should have both
disorders treated in an integrated way. Because these disorders often
occur in the same individual, patients presenting for one condition should be
assessed and treated for the other.
9. Medical
detoxification is only the first stage of addiction treatment and by itself
does little to change long-term drug use. Medical detoxification manages the
acute physical symptoms of withdrawal. For some individuals it is a precursor
to effective drug addiction treatment.
10. Treatment does not
need to be voluntary to be effective. Sanctions or enticements in the family,
employment setting, or criminal justice system can significantly increase
treatment entry, retention, and success.
11. Possible drug use
during treatment must be monitored continuously. Monitoring a
patient's drug and alcohol use during treatment, such as through urinalysis,
can help the patient withstand urges to use drugs. Such monitoring also can
provide early evidence of drug use so that treatment can be adjusted.
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 them or others at risk of infection. Counseling can help
patients avoid high-risk behavior and 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. Participation in
self-help support programs during and following treatment often helps maintain
abstinence. "
Principles
of Drug Addiction Treatment: A Research-based Guide (NCADI
publication BKD347) has been mailed to NIDA NOTES subscribers in the
U.S. Copies of the booklet can be obtained from the National Clearinghouse
for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20847,
1-800-729-6686.
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