Drug Addiction Treatments

Many approaches to drug addiction treatment and individual programs today do not fit neatly into traditional drug addiction treatment classifications and they continue to evolve and diversify. Scientific studies normally have classified programs into various modalities for Addiction Treatment.

Most approaches generally follow a standard set of methods.  They usually start  with DETOXIFICATION and withdrawal that is medically managed which is usually considered the first stage of treatment.

 Detoxification is process by which the body clears itself of drugs. Stopping drug use results in acute and potentially dangerous physiological effects which detoxification is designed to manage. Psychological, social, and behavioral problems associated with addiction are not addressed alone by detoxification as stated previously, and it does not normally produce lasting behavioral changes necessary for recovery unless they address the biochemical issue of addiction by using substition therapy, i.e. suboxone therapy.

An outpatient program utilizes substitution therapy also called substitution therapy i.e. suboxone therapy. The exception would be an opiate program utilizing suboxone therapy i.e. substitution therapy.

A formal assessment and referral to Drug Addiction Treatment should follow detoxification.

Detoxification is referred to as "medically managed withdrawal" and is often managed by a physician including medications in an inpatient or outpatient setting because it is often accompanied by unpleasant and potentially fatal side effects stemming from withdrawal. Opioid, benzodiazepine, alcohol, nicotine, barbiturate, and other sedative withdrawal can be tempered with medications.

Additional Reading:

Kleber, H.D. Outpatient DETOXIFICATION from opiates.Primary Psychiatry 1:42-52, 1996.

Long-Term Residential Treatment

Generally practiced in non-hospital settings and providing care 24 hours a day is Long-term residential treatment . Therapeutic community (TC) is the best-known residential treatment model, with planned lengths of stay of from 6 to 12 months. The "resocialization" of the individual  and using the program’s entire community including other residents, staff, and the social context as active components of treatment are what TCs focus on. Treatment focuses on developing personal accountability, responsibility and socially productive lives.   Treatment is highly structured and can be confrontational at times with addiction being viewed in the context of an individual’s social and psychological deficits. ACTIVITIES are designed to help residents examine damaging beliefs, self-concepts, and destructive patterns of behavior and adopt new, more harmonious and constructive ways to interact with others. Some TCs offer comprehensive services, which can include employment training and other support services, onsite. TCs can be modified to treat individuals with special needs according to research, including adolescents, women, homeless individuals, people with severe mental disorders, and individuals in the criminal justice system (see "Treating Criminal Justice-Involved Drug Abusers and Addicted Individuals").

Further Reading:

Lewis, B.F.; McCusker, J.; Hindin, R.; Frost, R.; and Garfield, F. Four residential DRUG TREATMENT programs: Project IMPACT. In: J.A. Inciardi, F.M. Tims, and B.W. Fletcher (eds.), Innovative Approaches in the Treatment of Drug Abuse, Westport, CT: Greenwood Press, pp. 45-60, 1993.

Sacks, S.; Banks, S.; McKendrick, K.; and Sacks, J.Y. Modified therapeutic community for co-occurring disorders: A summary of four studies. Journal of SUBSTANCE ABUSE TREATMENT34(1):112-122, 2008.

Sacks, S.; Sacks, J.; DeLeon, G.; Bernhardt, A.; and Staines, G. Modified therapeutic community for mentally ill chemical "abusers": Background; influences; program DESCRIPTION; preliminary findings. Substance Use and Misuse 32(9):1217-1259, 1997.

Stevens, S.J., and Glider, P.J. Therapeutic communities: Substance abuse treatment for women. In: F.M. Tims, G. DeLeon, and N. Jainchill (eds.), Therapeutic Community: Advances in Research and Application, National Institute on Drug Abuse Research Monograph 144, NIH Pub. No. 94-3633, U.S. Government Printing Office, pp. 162-180, 1994.

Sullivan, C.J.; McKendrick, K.; Sacks, S.; and Banks, S.M. Modified therapeutic community for offenders with MICA disorders: Substance use outcomes. American Journal of DRUG AND ALCOHOL ABUSE 33(6):823-832, 2007.

Short-Term Residential Treatment

Short-term residential Drug Addiction Treatment Programs provide intensive but relatively brief treatment based on a modified 12-step approach. These programs were originally designed to treat alcohol problems, but during the cocaine epidemic of the mid-1980s, many began to treat other types of substance use disorders. The original residential treatment model consisted of a 3- to 6-week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in a self-help group, such as AA. Following stays in residential treatment programs, it is important for individuals to remain engaged in outpatient treatment programs and/or aftercare programs. These programs help to reduce the risk of relapse once a patient leaves the residential setting.

Further Reading:

Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; Anderson, J.; and Etheridge, R.M. Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4):291-298, 1998.

Miller, M.M. Traditional approaches to the treatment of addiction. In: A.W. Graham and T.K. Schultz (eds.), Principles of Addiction Medicine (2nd ed.). Washington, D.C.: American Society of Addiction Medicine, 1998.

Outpatient Treatment Programs

Outpatient drug addiction treatment varies in the types and intensity of services offered. Such treatment costs less than residential or inpatient treatment and often is more suitable for people with jobs or extensive social supports. It should be noted, however, that low-intensity PROGRAMS may offer little more than drug education. Other outpatient models, such as intensive day treatment, can be comparable to residential programs in services and effectiveness, depending on the individual patient’s characteristics and needs. In many outpatient programs, group counseling can be a major component. Some outpatient programs are also designed to treat patients with medical or other mental health problems in addition to their drug disorders.

Further Reading:

Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; Anderson, J.; and Etheridge, R.M. Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4):291-298, 1998.

Institute of Medicine. Treating Drug Problems. Washington, D.C.: National Academy Press, 1990.

McLellan, A.T.; Grisson, G.; Durell, J.; Alterman, A.I.; Brill, P.; and O'Brien, C.P. SUBSTANCE ABUSE TREATMENT in the private setting: Are some PROGRAMS more effective than others?Journal of Substance Abuse Treatment 10:243-254, 1993.

Simpson, D.D., and Brown, B.S. Treatment retention and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4):294-307, 1998.

Individualized Drug Counseling

Individualized DRUG COUNSELING not only focuses on reducing or stopping illicit drug or alcohol use; it also addresses related areas of impaired functioning—such as employment status, illegal activity, and family/social relations—as well as the content and structure of the patient’s recovery program. Through its emphasis on short-term behavioral goals, individualized counseling helps the patient develop coping strategies and tools to abstain from drug use and maintain abstinence. The addiction counselor encourages 12-step participation (at least one or two times per week) and makes referrals for needed supplemental medical, psychiatric, employment, and other services.

Group Counseling

Many therapeutic settings use group therapy to capitalize on the social reinforcement offered by peer discussion and to help promote drug-free lifestyles. Research has shown that when group therapy either is offered in conjunction with individualized drug counseling or is formatted to reflect the principles of cognitive-behavioral therapy or contingency management, positive outcomes are achieved. Currently, researchers are testing conditions in which group therapy can be standardized and made more community-friendly.

Treating Criminal Justice-Involved Drug Abusers and Addicted Individuals

Often, drug abusers come into contact with the criminal justice system earlier than other health or social systems, presenting opportunities for intervention and treatment prior to, during, after, or in lieu of incarceration. Research has shown that combining criminal justice sanctions with  Drug Addiction Treatment can be effective in decreasing drug abuse and related crime. Individuals under legal coercion tend to stay in treatment longer and do as well as or better than those not under legal pressure. Studies show that for incarcerated individuals with drug problems, starting drug abuse treatment in prison and continuing the same treatment upon release—in other words, a seamless continuum of services—results in better outcomes: less drug use and less criminal behavior. More information on how the criminal justice system can address the problem of drug addiction can be found in Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide  (National Institute on Drug Abuse, revised 2012).

For further information see our new book Addicted Kids; Our Lost Generation.