NOTE: This is a fact sheet covering research findings on effective
treatment approaches for drug abuse and addiction. If you are seeking
treatment, please call the Substance Abuse and Mental Health Services
Administration's (SAMHSA) National Drug and Alcohol Treatment Service at
1–800–662–HELP (4357) for information on hotlines, counseling services,
or treatment options in your State. Drug treatment programs by State
also may be found online at
www.findtreatment.samhsa.gov.
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 drug addiction begins with
the voluntary act of taking drugs, over time a person's ability to
choose not to do so becomes compromised, and seeking and consuming the
drug becomes compulsive. This behavior results largely from the effects
of prolonged 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 drug abuse and addiction have so many dimensions and disrupt
so many aspects of an individual's life, treatment is not simple.
Effective treatment programs typically incorporate many components, each
directed to a particular aspect of the illness and its consequences.
Addiction treatment 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 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.
Too often, 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
treatment for an illicit drug or alcohol use problem in 2007. Of these
individuals, 2.4 million (10.4 percent of those who needed treatment)
received treatment at a specialty facility (i.e., hospital, drug or
alcohol rehabilitation or mental health center). Thus, 20.8 million
persons (8.4 percent of the population aged 12 or older) needed
treatment for an illicit drug or alcohol use problem but did not receive
it. These estimates are similar to those in previous years.
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Principles of Effective Treatment
Scientific research since the mid–1970s shows that treatment 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 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 treatment is appropriate for everyone.
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Treatment needs to be readily available.
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Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
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Remaining in treatment 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 drug abuse treatment.
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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 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 addiction
treatment and by itself does little to change long–term drug abuse.
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Treatment does not need to be voluntary to be effective.
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Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
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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
treatment; preventing relapse is necessary for maintaining its effects.
And sometimes, as with other chronic conditions, episodes of relapse may
require a return to prior 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 treatment process.
Withdrawal. Medications offer help in suppressing
withdrawal symptoms during detoxification. However, medically assisted
detoxification is not in itself "treatment"—it is only the first step in
the treatment process. Patients who go through medically assisted
withdrawal but do not receive any further treatment 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 opioids (heroin, morphine),
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 treatment 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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Tobacco: A variety of formulations of nicotine replacement
therapies now exist—including the patch, spray, gum, and lozenges—that
are available over the counter. In addition, two prescription
medications have been FDA–approved for tobacco addiction: bupropion and
varenicline. They have different mechanisms of action in the brain, but
both help prevent relapse in people trying to quit. Each of the above
medications is recommended for use in combination with behavioral
treatments, including group and individual therapies, as well as
telephone quitlines.
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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 treatment 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 treatment 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 treatment.
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Motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.
Residential treatment programs 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—treatment 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 resocialization of the patient to a drug-free,
crime–free lifestyle.
Treatment Within the Criminal Justice System
Treatment 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 treatment 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 (
o en Español).
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.
References
Data is from the National Survey on Drug Use and Health (formerly
known as the National Household Survey on Drug Abuse), which is an
annual survey of Americans age 12 and older conducted by the Substance
Abuse and Mental Health Services Administration. This survey is
available online at
www.samhsa.gov and from NIDA at 877-643-2644.