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About Addiction and Substance Abuse Treatment
How Does Treatment Benefit Society?
NIDA’s 13 Principles of Effective Treatment
What is treatment?
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines treatment as “a path of recovery that can involve many interventions and attempts at abstinence. It is offered in different settings, and types of treatment greatly depend on the substances misused, as well as a person’s individual needs and characteristics. Treatment is offered in residential and outpatient programs and can include counseling or other behavioral therapy, family therapy, medication, or a combination of services.”13
How is addiction defined?
The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine recognize the following definition of addiction.16
“Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.”
Is addiction a disease?
Numerous studies have demonstrated that chronic substance use changes the brain in fundamental ways that endure long after substance misuse and abuse has ended. The National Institute on Drug Abuse (NIDA) Web site states, “Addiction is a real and complex disease similar to other chronic diseases such as type II diabetes, cancer and heart disease. Imaging studies have shown evidence of tissue malfunction in the brains of those with addiction. There is often a genetic factor, meaning it can run in families.” Like other chronic medical conditions, substance use disorders are medical conditions and can be treated effectively.14
Does treatment work?
Research shows that substance use disorders are medical conditions that can be effectively treated, just as many illnesses are treatable. SAMHSA notes, “A major study published in 2000 in the Journal of the American Medical Association is one of several that demonstrate the effectiveness of treatment for substance use disorders. The study found that treatments for drug use disorders are just as effective as treatments for other chronic conditions, such as high blood pressure, asthma, and diabetes.”13
NIDA indicates that relapse does not mean that treatment has failed. “The chronic nature of the disease means that relapsing to drug abuse is not only possible, but likely, with relapse rates similar to those for other well-characterized chronic medical illnesses such as diabetes, hypertension, and asthma, which also have both physiological and behavioral components. Treatment of chronic diseases involves changing deeply imbedded behaviors, and relapse does not mean treatment failure. For the addicted patient, lapses back to drug abuse indicate that treatment needs to be reinstated or adjusted, or that alternate treatment is needed.”22
What is Recovery?
SAMHSA defines recovery from alcohol and drug problems as “a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life.” The distinction between treatment and recovery is important. The Recovery Services Community Programs Web site explains that “recovering from alcohol and drug use disorders is a highly individualized experience, and everyone who goes through the experience has an individual definition of recovery. In addition, recovery is achieved via many different pathways. Within the RCSP projects, an emerging definition goes beyond abstinence alone to include a full re-engagement—based on resilience, health, and hope—with one’s family, friends, and community.”
How does treatment benefit society?
Recent cost benefit studies consistently find that benefits to society of addiction treatment are greater than the costs of addiction treatment. As people participate in treatment and find recovery there is reduced crime, improved health, lower health care costs and improved employment and social functioning. Helping one person achieve recovery from a substance use disorder through effective treatment programs and other support services can improve many lives.
Materials from SAMHSA’s 2007 Recovery Month campaign say, “Many studies show a positive return on investment when money is spent on treatment. Research suggests at least a 2:1 benefit-to-cost ratio, with other studies allowing for a return of $7 for every dollar spent on treatment. Another study discovered as much as a $23 return for every dollar spent on treatment. While the return on investment varies from state to state and program to program, evidence supports the overall positive financial gain to society when investing in the treatment of people with substance use disorders. … Research has consistently found that people who have untreated substance use disorders typically have high rates of repeated contacts with the justice system and a greater chance of re-incarceration. However, when inmates receive treatment for a substance use disorder, re-arrests have shown to drop from 75 percent to 27 percent.”13
SAMHSA’s Treatment Facility Locator
The Substance Abuse and Mental Health Services Administration provides a searchable directory of drug and alcohol treatment programs around the country. The Locator includes more than 10,000 addiction treatment programs, including residential treatment centers, outpatient treatment programs, and hospital inpatient programs for drug addiction and alcoholism.
NIDA’s 13 Principles of Effective Treatment
A 1999 publication from the National Institute on Drug Abuse called Principles of Drug Addiction Treatment: A Research Based Guide, highlights 13 overarching principles that define effective drug treatment. A brief description of each principle is listed below.22
- 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 accessible.
- 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. 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 treatment interventions.
- 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.
- 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.
