Drug Addiction Treatment

Principles of Drug Addiction and Alcoholism Treatment: A Research-Based Guide (Third Edition)

Principles of Effective Treatment

1. Addiction is a complex but treatable disease that affects brain function and behavior.  Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences.

2. No single treatment is appropriate for everyone.  Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an 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.

3. Treatment needs to be readily available.  Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.

4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.  To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.

5. Remaining in treatment for an adequate period of time is critical.  The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.

6. Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment.   Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.

7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.  For example, methadone, buprenorphine, and naltrexone (including a new long-acting formulation) are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (available as patches, gum, lozenges, or nasal spray) or an oral medication (such as bupropion or varenicline) can be an effective component of treatment when part of a comprehensive behavioral treatment program.

8. 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.  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 may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person’s changing needs.

9. Many drug-addicted individuals also have other mental disorders.  Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both (or all), including the use of medications as appropriate.

10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.  Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement.

11. Treatment does not need to be voluntary to be effective.  Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.

12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.  Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.

13. Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary.   Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness. Moreover, engaging in substance abuse treatment can facilitate adherence to other medical treatments. Substance abuse treatment facilities should provide onsite, rapid HIV testing rather than referrals to offsite testing—research shows that doing so increases the likelihood that patients will be tested and receive their test results. Treatment providers should also inform patients that highly active antiretroviral therapy (HAART) has proven effective in combating HIV, including among drug-abusing populations, and help link them to HIV treatment if they test positive.

More at; http://www.drugabuse.gov/publications/principles-drug-addiction-treatment

Hepatitis C

Hepatitis C in alcoholism, addiction The highest rates of hepatitis C are in addicts and alcoholics.

Hepatitis C is a chronic liver disease caused by the hepatitis C virus (HCV). Because many people do not have symptoms when they are infected, it is important for those at risk to take action to avoid infecting others.

Background

Although HCV has existed for a long time, it was only identified in 1989. HCV causes inflammation of the liver, which can progress to cirrhosis (extensive scarring that can affect the normal function of the liver).

Some people recover from their infection, but 75-85% progress to the chronic (carrier) state. People with chronic hepatitis C may not have symptoms for decades. Approximately 35% of those who have chronic hepatitis C, do not know that they are infected.

Other topics in this article are;

  • Health Risks of Hepatitis C
  • The Health Effects of Hepatitis C
  • Minimizing Your Risk

Full story at; Health Canada

See also;

Hepatitis B

Doctor assessing Hepatitis B in alcoholism Some of the highest rates of hepatitis B are in alcoholics and addicts.

Hepatitis B is a liver disease caused by the hepatitis B virus. The virus is carried in blood and body fluids. It can lead to serious liver damage, life-long infection, liver cancer, liver failure and even death. Fortunately, there is a vaccine that can protect you against hepatitis B.

Background

Hepatitis B virus (HBV) is one of a group of viruses that attacks the liver. Six hepatitis viruses have been identified but three – known as A, B, and C – cause about 90% of the acute hepatitis cases in Canada.

HBV is the most common form of hepatitis virus in the world. It is easily transmitted and is significantly more infective than HIV. HBV is primarily transmitted from one person to another through blood or other body fluids, such as vaginal secretions and semen. It is usually spread through sexual contact or by sharing contaminated needles or other drug equipment. It can also be transmitted from mother to child during pregnancy and birth.

The majority of people infected with HBV do not have noticeable symptoms and may unknowingly be experiencing liver damage and infecting others. That is why it is important for those most at risk to be vaccinated against the virus and avoid risky behaviour.

Topics in the linked article include;

  • Symptoms of HBV
  • Risks of Hepatitis B Exposure
  • The Health Effects of Hepatitis B
  • Minimizing Your Risk

Full story at; Health Canada

See also;

Recovery Focused Approach to Tackling Drug Use in Scotland

Scots flag Recovery Focused Approach to Tackling Drug Use in Scotland

Scotland’s first national drugs strategy The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem was launched on May 29, 2008. The Government believes that preventing drug use is more effective than treating established drug problems and that treatment services in Scotland should be based on the principle of recovery.

The key priorities are:

  • better prevention of drug problems, with improved life chances for children and young people
  • more people recovering from problem drug use
  • communities that are safer and stronger places to live and work
  • ensuring that children affected by parental substance use are safer
  • improving the effectiveness of delivery at a national and local level

The Government’s vision for how drug treatment services in Scotland should be delivered is based on the principle that recovery should be the explicit aim of all services providing treatment and rehabilitation for people with problem drug use.

‘Recovery’ is the principle that people suffering from problem drug use should receive support which does more than just reduce the immediate risks and harms of addiction. Individuals become active participants in their own care, moving forward in the hope and belief that they will get better.

What do we mean by recovery?

We mean a process through which an individual is enabled to move on from their problem drug use, towards a drug-free life as an active and contributing member of society. Recovery is most effective when service users’ needs and aspirations are placed at the centre of their care and treatment. There is no right or wrong way to recover.

The Road to Recovery sets out the Government’s vision of recovery as an achievable goal for people with problem drug use and the actions it intends to carry out to promote a shared understanding of how to promote and support recovery. These include establishing and supporting a ‘recovery network’, building the capacity of services which can help services users choose the treatment that is right for them, and ensuring that the principles of recovery are reflected in the reform of delivery arrangements and in training and workforce development programmes.