Principles of effective treatment
|Principles of Effective
Principles of Effective Treatment
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.
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
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.
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.
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 (see
pages 11-49). 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.
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. (Approaches to Drug Addiction Treatment section
discusses details of different treatment components to
accomplish these goals.)
Medications are an important element of treatment for many
patients, especially when combined with counseling and other
behavioral therapies. Methadone and levo-alpha-acetylmethadol (LAAM)
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) can be an effective component of
treatment. For patients with mental disorders, both behavioral
treatments and medications can be critically important.
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.
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 (see Drug Addiction Treatment Section).
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
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
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.
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 abstinence.
Cite: NIDA Link
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