04 treatment and continuous treatment

• Drug abuse treatment approaches

  • Behavioral therapy
  • Medications
  • Combination of therapies and other services
• Steps to recovery

  1. Recognition

  2. Detoxification

  3. Rehabilitation

  4. Abstinence
• Treatment can take various lengths of time and can occur in many different forms in a variety of settings
• A one-time short-term treatment is ineffective
• Good outcomes are dependent on adequate length of treatment
• 13 general principles of effective addiction treatment adopted by NIDA


  • 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 use
  • 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
  • Remaining in treatment for an adequate period of time is critical for treatment effectiveness
  • Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction
  • Medications are an important element of treatment for many patients, 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 detoxification 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 counseling to help patients modify or change behaviors that place themselves or others at risk of infection
  • Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment
• Pharmacological treatment for drug abuse

  • Opioid Addiction
  • Alcohol Addiction
  • Nicotine Addiction
• Opioid agonist maintenance therapy


  1. Methadone maintenance therapy (MMT)

  2. Methadone blocks the effects of illicit opioid use and reduces craving

  3. Patients stabilized on adequate, sustained dosages of methadone can function normally

  4. Patients stabilized on opioid agonist can engage more readily in counseling and other behavioral interventions essential to recovery and rehabilitation

  5. Methadone reduces the risk of HIV infection
• Opioid antagonist therapy


  1. Naltrexone occupies the opioid receptors at CNS and the addict taking the ordinary doses of drug does not experience the desired drug effect

  2. This causes the drug taking behavior to be extinguished as long as the person takes naltrexone

  3. Naloxone is often used as an antidote for opioid overdose
• Disulfiram therapy


  1. Disulfiram inhibits the enzyme acetaldehyde dehydrogenase which is necessary to convert acetaldehyde to acetic acid in the body, leading to increase in blood aldehyde levels

  2. This increased levels of acetaldehyde causes highly unpleasant symptoms

  3. Disulfiram alone does not treat withdrawal from alcohol or reduce the craving for alcohol; it acts as a prevention aid only

  4. Naltrexone reduces alcohol consumption and craving

  5. Acamprosate is a GABA agonist and NMDA receptor antagonist

  6. The combination of naltrexone and acamprosate is being used to treat the physiological changes in CNS associated with alcohol abuse
• Nicotine replacement therapy (NRT)

  • Nicotine gum
  • Nicotine patches
  • Nicotine nasal spray
  • Nicotine lozenges
  • Nicotine inhalers
• Other pharmacological therapies

  1. Clonidine is useful in treating opiate dependent people during the withdrawal stages

  2. Bupropion is an antidepressant medication, which reduces the symptoms of nicotine withdrawal
• Alcohol rehabilitation programme/ medical detoxification


  1. Medical detoxification is a process whereby individuals are systematically withdrawn from addicting drugs in an inpatient or outpatient setting, typically under the care of a physician

  2. Medications are available for detoxification from opiates, nicotine, BZDs, alcohol, barbiturates and other sedatives

  3. Untreated withdrawal may be medically dangerous or even fatal
• Outpatient rehabilitation programme


  1. Treatment costs less than residential or inpatient treatment

  2. Group counseling is emphasized

  3. Clients' medical, psychological, social, behavioral, emotional and spiritual needs are treated

  4. Clients attend treatment during the day and return home or to a sober living facility in the evening
• Long-term residential rehab programme


  1. Individuals move into a room which is set-up similar to a dorm, or apartment style living, while receiving care 24/7

  2. The therapeutic community (TC) model focuses on the 'Resocialization' of the individual and uses the program's entire 'Community' as active components of treatment

  3. Offers medical exams, psychological exams, psychiatric consultations, individual sessions with a doctor, individual counseling, group therapy, back to work planning, relapse prevention and sober living skills