Institute publishes "Principles of Drug Addiction Treatment"

October 12, 1999

Research-Based Guide Highlights Effectiveness of Treatment

The National Institute on Drug Abuse (NIDA) today published the first-ever, science-based guide to drug addiction treatment. In its Principles of Drug Addiction Treatment: A Research-Based Guide, the Institute outlines some of the essential components of drug addiction and its treatment based on 30 years of scientific research.

"There is no 'one size fits all' drug addiction treatment program," said Dr. Alan I. Leshner, NIDA's Director. "Because addiction has so many dimensions and disrupts so many aspects of an individual's life, the best programs provide a combination of therapies and other services, such as referral to other medical, psychological, and social services. The combination of treatment components and services to be employed must be tailored to meet the needs of the individual, including where he or she is in the recovery process."

He also noted that treatment is tremendously cost effective -- it's estimated that for every $1 spent on addiction treatment programs, there is a $4 to $7 reduction in drug-related crime, criminal justice costs and theft alone. When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and to society also come from significant drops in interpersonal conflicts, improvements in workplace productivity, and reductions in drug-related accidents.

The publication of the Principles coincides with an article in the October 13 issue of The Journal of the American Medical Association (JAMA). In the JAMA article Dr. Leshner noted, "advances in science have greatly increased, and in fact revolutionized, our fundamental understanding of the nature of drug abuse and addiction, and, most importantly, what to do about it."

He continued, "Although the onset of addiction begins with the voluntary act of taking drugs, the continued repetition of 'voluntary' drug taking begins to change into 'involuntary' drug taking, ultimately to the point where the behavior is driven by compulsive craving for the drug. This compulsion results from a combination of factors, including in large part dramatic changes in brain function produced by prolonged drug use. This is why addiction is considered a brain disease -- one with imbedded behavioral and social context aspects. Once addicted, it is almost impossible for most people to stop the spiraling cycle of addiction on their own without treatment."

While the JAMA article was written primarily to inform physicians about drug addiction and the effectiveness of treatment, the Principles of Drug Addiction Treatment booklet is intended for health care professionals and the general public.

Among the principles and concepts spelled out in this guide, Dr. Leshner emphasized two points: treatment of addiction is as successful as treatment of other chronic diseases such as diabetes, hypertension, and asthma, and for those with severe addiction problems, participation in treatment for less than 90 days is of limited or no effectiveness.

"Three decades of research and clinical practice have revolutionized our understanding of drug abuse. It is hoped that these treatment principles will serve as a foundation for replacing ideologies about drug addiction with science-based treatment," Dr. Leshner said.

In addition to outlining the principles, NIDA's publication includes answers to frequently asked questions about addiction, an overview of drug addiction treatment in the United States, and a brief discussion of the science-based approaches to drug addiction treatment with suggestions for further reading.
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Note to Reporters: The full text of Dr. Leshner's article, "Science-Based Views of Drug Addiction and Its Treatment," can be found in The Journal of the American Medical Association (JAMA, 1999; 282:1314-1316). For a copy of the article, call the American Medical Association's (AMA) Science News Department at 312-464-5374.

Free copies of the Principles of Drug Addiction Treatment: A Research-Based Guide are available on NIDA's website at www.nida.nih.gov or by calling 1-800-729-6686.

NIDA supports more than 85 percent of the world's research on the health aspects of drug abuse and addiction. The Institute also carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Fact sheets on health effects of drugs of abuse and other topics can be ordered free of charge in English and Spanish, by calling NIDA Infofax at 1-888-NIH-NIDA (-644-6432) or 1-888-TTY-NIDA (-889-6432) for the deaf. These fact sheets and further information on NIDA research and other activities can be found on the NIDA home page at http://www.nida.nih.gov.
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NATIONAL INSTITUTE ON DRUG ABUSE THIRTEEN PRINCIPLES OF DRUG ADDICTION TREATMENT FROM PRINCIPLES OF DRUG ADDICTION TREATMENT: A RESEARCH-BASED GUIDE*

1. No single treatment is appropriate for all individuals. Matching treatment setting, 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 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.

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 abstinence.

Note: Free copies of the Principles of Drug Addiction Treatment: A Research-Based Guide are available by calling 1-800-729-6686 or from NIDA's website at www.nida.nih.gov .

*Source: Principles of Drug Addiction Treatment: A Research-Based Guide, National Institute on Drug Abuse, NIH Publication No. 99-4180, Printed October 1999.

NIH/National Institute on Drug Abuse

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