Learning Objectives

Clinicians will be able to:

1. Apply the Principles Of Effective Treatment with people who are drug addicts.

2. Describe diferent types of drug abuse treatment

3. Discuss the key componenets in evidence-based approaches to drug addiction treatment.

4. Make appropriate referrals and coordinate services.

5. Define substance abuse treatment in the context of counseling, family systems, and community education.

6. Describe the importance of cultural competence in regard to  substance abuse treatment

7. Demonstrate professional and ethical responsibilities.

8. Discuss current medications available to treat drug abuse with pregnant women.

9. Know the goals and components of substance abuse treatment with pregnant women.

10. Apply early intervention efforts during the prenatal period to increase the likelihood that a pregnant woman will successfully recover from alcohol and other drug abuse.

11. List the dangers to the fetus of substance abuse during pregnancy, including intrauterine growth retardation, prematurity and low birth weight, central nervous system damage, and congenital physical malformations.

12. Review the need for gender specific substance abuse treatment to meet the needs of pregnant women.

13. Know the impact of the legal system as it impacts on substance abusing pregnant women

Principles Of Effective Treatment

1. 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.

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 a ddition 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 (see pages 13-51). 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. (Pages 37-51 discuss details of different treatment components to accomplish these goals.)

7. Medications are an important element of treatment for many patients, especially when combined with counseling and other Behavioral therapies. Methadone and levo-alphaacetylmethadol (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 (see pages 25-35).

10.Treatment does not need to be voluntary to be effective. Strong motivation can facilitate thetTreatment 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.