- No single treatment
is appropriate for all individuals.
Matching treatment settings, interventions,
and services to each patient's problems and
needs is critical.
- Treatment needs
to be readily available. Treatment
applicants can be lost if treatment is not immediately
available or readily accessible.
- 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.
- At different
times during treatment, a patient may develop
a need for medical services, family therapy,
vocational rehabilitation, and social and legal
services.
- 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.
- 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.
- Medications
are an important element of treatment for many
patients, especially when combined with counseling
and other behavioral therapies.
Methadone and levo-alpha-acetylmethodol (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 buproprion, can help persons addicted
to nicotine.
- Addicted or
drug-abusing individuals with coexisting mental
disorders should have both disorders treated
in an integrated way.
- 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.
- 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.
- 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.
- 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.
- 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.
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