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Drug Abuse & Treatment:
Drug Abuse:

Many people view drug abuse and addiction as strictly a social problem. Parents,
teens,older adults, and other members of the community tend to characterize people who
take drugs as morally weak or as having criminal tendencies. They believe that drug
abusers and addicts should be able to stop taking drugs if they are willing to change their
behavior.

These myths have not only stereotyped those with drug-related problems, but also their
families, their communities, and the health care professionals who work with them. Drug
abuse and addiction comprise a public health problem that affects many people and has
wide-ranging social consequences. It is
NIDA's goal to help the public replace its myths and
long-held mistaken beliefs about drug abuse and addiction with scientific evidence that
addiction is a chronic, relapsing, and treatable disease.

Addiction does begin with drug abuse when an individual makes a conscious choice to use
drugs, but addiction is not just "a lot of drug use." Recent scientific research provides
overwhelming evidence that not only do drugs interfere with normal brain functioning
creating powerful feelings of pleasure, but they also have long-term effects on brain
metabolism and activity. At some point, changes occur in the brain that can turn drug abuse
into addiction, a chronic, relapsing illness. Those addicted to drugs suffer from a compulsive
drug craving and usage and cannot quit by themselves. Treatment is necessary to end this
compulsive behavior.

A variety of approaches are used in treatment programs to help patients deal with these
cravings and possibly avoid drug relapse. NIDA research shows that addiction is clearly
treatable. Through treatment that is tailored to individual needs, patients can learn to
control their condition and live relatively normal lives.

Treatment can have a profound effect not only on drug abusers, but on society as a whole
by significantly improving social and psychological functioning, decreasing related criminality
and violence, and reducing the spread of AIDS. It can also dramatically reduce the costs to
society of drug abuse.

Understanding drug abuse also helps in understanding how to prevent use in the first
place. Results from NIDA-funded prevention research have shown that comprehensive
prevention programs that involve the family, schools, communities, and the media are
effective in reducing drug abuse. It is necessary to keep sending the message that it is
better to not start at all than to enter rehabilitation if addiction occurs.

A tremendous opportunity exists to effectively change the ways in which the public
understands drug abuse and addiction because of the wealth of scientific data NIDA has
amassed. Overcoming misconceptions and replacing ideology with scientific knowledge is
the best hope for bridging the "great disconnect" - the gap between the public perception
of drug abuse and addiction and the scientific facts.

Drug Treatment:

Drug addiction is a treatable disorder. Through treatment that is tailored to individual
needs, patients can learn to control their condition and live normal, productive lives. Like
people with diabetes or heart disease, people in treatment for drug addiction learn
behavioral changes and often take medications as part of their treatment regimen.

Behavioral therapies can include counseling, psychotherapy, support groups, or family
therapy. Treatment medications offer help in suppressing the withdrawal syndrome and
drug craving and in blocking the effects of drugs. In addition, studies show that treatment
for heroin addiction using methadone at an adequate dosage level combined with
behavioral therapy reduces death rates and many health problems associated with heroin
abuse.

In general, the more treatment given, the better the results. Many patients require other
services as well, such as medical and mental health services and HIV prevention services.
Patients who stay in treatment longer than 3 months usually have better outcomes than
those who stay less time. Patients who go through medically assisted withdrawal to
minimize discomfort but do not receive any further treatment, perform about the same in
terms of their drug use as those who were never treated. Over the last 25 years, studies
have shown that treatment works to reduce drug intake and crimes committed by
drug-dependent people. Researchers also have found that drug abusers who have been
through treatment are more likely to have jobs. The ultimate goal of all drug abuse
treatment is to enable the patient to achieve lasting abstinence, but the immediate goals
are to reduce drug use, improve the patient's ability to function, and minimize the medical
and social complications of drug abuse.

There are several types of drug abuse treatment programs. Short-term methods last less
than 6 months and include residential therapy, medication therapy, and drug-free
outpatient therapy. Longer term treatment may include, for example, methadone
maintenance outpatient treatment for opiate addicts and residential therapeutic community
treatment.

In maintenance treatment for heroin addicts, people in treatment are given an oral dose of
a synthetic opiate, usually methadone hydrochloride or levo-alpha-acetyl methadol (LAAM),
administered at a dosage sufficient to block the effects of heroin and yield a stable,
noneuphoric state free from physiological craving for opiates. In this stable state, the
patient is able to disengage from drug-seeking and related criminal behavior and, with
appropriate counseling and social services, become a productive member of his or her
community.

Outpatient drug-free treatment does not include medications and encompasses a wide
variety of programs for patients who visit a clinic at regular intervals. Most of the programs
involve individual or group counseling. Patients entering these programs are abusers of
drugs other than opiates or are opiate abusers for whom maintenance therapy is not
recommended, such as those who have stable, well-integrated lives and only brief histories
of drug dependence.

Therapeutic communities (TCs) are highly structured programs in which patients stay at a
residence, typically for 6 to 12 months. Patients in TCs include those with relatively long
histories of drug dependence, involvement in serious criminal activities, and seriously
impaired social functioning. The focus of the TC is on the resocialization of the patient to a
drug-free, crime-free lifestyle.

Short-term residential programs, often referred to as chemical dependency units, are often
based on the "Minnesota Model" of treatment for alcoholism. These programs involve a 3- to
6-week inpatient treatment phase followed by extended outpatient therapy or participation
in 12-step self-help groups, such as Narcotics Anonymous or Cocaine Anonymous. Chemical
dependency programs for drug abuse arose in the private sector in the mid-1980s with
insured alcohol/cocaine abusers as their primary patients. Today, as private provider
benefits decline, more programs are extending their services to publicly funded patients.

Methadone maintenance programs are usually more successful at retaining clients with
opiate dependence than are therapeutic communities, which in turn are more successful
than outpatient programs that provide psychotherapy and counseling. Within various
methadone programs, those that provide higher doses of methadone (usually a
minimum of 60 mg.) have better retention rates. Also, those that provide other services,
such as counseling, therapy, and medical care, along with methadone generally get better
results than the programs that provide minimal services.

Drug treatment programs in prisons can succeed in preventing patients' return to criminal
behavior, particularly if they are linked to community-based programs that continue
treatment when the client leaves prison. Some of the more successful programs have
reduced the rearrest rate by one-fourth to one-half. For example, the "Delaware
Model," an ongoing study of comprehensive treatment of drug- addicted prison inmates,
shows that prison-based treatment including a therapeutic community setting, a work
release therapeutic community, and community-based aftercare reduces the probability of
rearrest by 57 percent and reduces the likelihood of returning to drug use by 37 percent.
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