Microsoft word - nida principles of drug addiction treatment.doc

Research-Based Principles of Drug Addiction Treatment

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 3 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 nondrug-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 buprenorphine 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, Zyban or Chantix) 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
Source: Principles of Drug Addiction Treatment: A Research-based Guide (NCADI publication BKD347). Copies of the booklet can be obtained from the National Clearinghouse for Alcohol and Drug Information, PO Box 2245, Rockville, MD 20847. 1-800-729-6686


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