Basis for Effective Treatment
 
Basis
Scientific research shows that treatment can help many people change destructive behaviors, avoid relapse, and successfully remove themselves from a life of substance abuse and addiction. 

Scientific research shows that treatment can help many people change destructive behaviors, avoid relapse, and successfully remove themselves from a life of substance abuse and addiction. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. Based on this research, key principles have been identified that should form the basis of any effective treatment program:

· No single treatment is appropriate for all individuals.
· Treatment needs to be readily available.
· Effective treatment attends to multiple needs of the individual, not just his or her drug addiction. 
· An individual’s treatment and services plan must be assessed often and modified to meet the person’s changing needs.
· Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
· Counseling and other behavioral therapies are critical components of virtually all effective treatments for addiction. 
· For certain types of disorders, medications are an important element of treatment, especially when combined with counseling and other behavioral therapies.
· Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. 
· Medical management of withdrawal syndrome is only the first stage of addiction treatment and by itself does little to change long-term drug use. 
· Treatment does not need to be voluntary to be effective. 
· Possible drug use during treatment must be monitored continuously. 
· Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and should provide counseling to help patients modify or change behaviors that place themselves or others at risk of infection. 
· As is the case with other chronic, relapsing diseases, recovery from drug addiction can be a long-term process and typically requires multiple episodes of treatment, including "booster" sessions and other forms of continuing care.

Effective Treatment Approaches

Medication and behavioral therapy, alone or in combination, are aspects 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 followup 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 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 withdrawal 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 re-establish normal brain function and to prevent relapse and diminish cravings throughout the treatment process. Currently, we have medications for opioid (heroin, morphine) and tobacco (nicotine) addiction, and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction.
Methadone and buprenorphine, for example, are effective medications for the treatment of opiate addiction. Acting on the same targets in the brain as heroin and morphine, these medications block the drug's effects, suppress withdrawal symptoms, and relieve craving for the drug. This helps patients to disengage from drug-seeking and related criminal behavior and be more receptive to behavioral treatments.

Buprenorphine: This is a relatively new and important treatment medication. NIDA-supported basic and clinical research led to the development of buprenorphine (Subutex or, in combination with naloxone, Suboxone), and demonstrated it to be a safe and acceptable addiction treatment. While these products were being developed in concert with industry partners, Congress passed the Drug Addiction Treatment Act (DATA 2000), permitting qualified physicians to prescribe narcotic medications (Schedules III to V) for the treatment of opioid addiction. This legislation created a major paradigm shift by allowing access to opiate treatment in a medical setting rather than limiting it to specialized drug treatment clinics. To date, nearly 10,000 physicians have taken the training needed to prescribe these two medications, and nearly 7,000 have registered as potential providers.

 
 
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