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Frequently Asked Questions
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How effective is drug addiction treatment?
In addition to stopping drug use, the goal of treatment is to return the
individual to productive functioning in the family, workplace, and community.
Measures of effectiveness typically include levels of criminal behavior,
family functioning, employability, and medical condition. Overall, treatment
of addiction is as successful as treatment of other chronic diseases,
such as diabetes, hypertension, and asthma.
Treatment of addiction is as successful as treatment of other chronic
diseases such as diabetes, hypertension, and asthma.
According to several studies, drug treatment reduces
drug use by 40 to 60 percent and significantly decreases criminal activity
during and after treatment. For example, a study of therapeutic community
treatment for drug offenders demonstrated that arrests for violent and
nonviolent criminal acts were reduced by 40 percent or more. Methadone
treatment has been shown to decrease criminal behavior by as much as 50
percent. Research shows that drug addiction treatment reduces the risk
of HIV infection and that interventions to prevent HIV are much less costly
than treating HIV-related illnesses. Treatment can improve the prospects
for employment, with gains of up to 40 percent after treatment.
Although these effectiveness rates hold in general, individual treatment
outcomes depend on the extent and nature of the patient's presenting problems,
the appropriateness of the treatment components and related services used
to address those problems, and the degree of active engagement of the
patient in the treatment process.
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How long does drug addiction treatment usually
last?
Individuals progress through drug addiction treatment at various speeds,
so there is no predetermined length of treatment. However, research has
shown unequivocally that good outcomes are contingent on adequate lengths
of treatment. Generally, for residential or outpatient treatment, participation
for less than 90 days is of limited or no effectiveness, and treatments
lasting significantly longer often are indicated. For methadone maintenance,
12 months of treatment is the minimum, and some opiate-addicted individuals
will continue to benefit from methadone maintenance treatment over a period
of years.
Many people who enter treatment drop out before receiving
all the benefits that treatment can provide. Successful outcomes may require
more than one treatment experience. Many addicted individuals have multiple
episodes of treatment, often with a cumulative impact.
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What helps people stay in treatment?
Since successful outcomes often depend upon retaining the person long
enough to gain the full benefits of treatment, strategies for keeping
an individual in the program are critical. Whether a patient stays in
treatment depends on factors associated with both the individual and the
program. Individual factors related to engagement and retention include
motivation to change drug-using behavior, degree of support from family
and friends, and whether there is pressure to stay in treatment from the
criminal justice system, child protection services, employers, or the
family.
Within the program, successful counselors are able to establish
a positive, therapeutic relationship with the patient. The counselor should
ensure that a treatment plan is established and followed so that the individual
knows what to expect during treatment. Medical, psychiatric, and social
services should be available.
Since some individual problems (such as serious mental illness, severe
cocaine or crack use, and criminal involvement) increase the likelihood
of a patient dropping out, intensive treatment with a range of components
may be required to retain patients who have these problems. The provider
then should ensure a transition to continuing care or "aftercare"
following the patient's completion of formal treatment.
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Is the use of medications like methadone simply replacing one drug
addiction with another?
No. As used in maintenance treatment, methadone and LAAM are not heroin
substitutes. They are safe and effective medications for opiate addiction
that are administered by mouth in regular, fixed doses. Their pharmacological
effects are markedly different from those of heroin.
Injected, snorted, or smoked heroin causes an almost immediate "rush"
or brief period of euphoria that wears off very quickly, terminating in
a "crash." The individual then experiences an intense craving
to use more heroin to stop the crash and reinstate the euphoria. The cycle
of euphoria, crash, and craving - repeated several times a day - leads
to a cycle of addiction and behavioral disruption.
These characteristics of heroin use result from the drug's rapid onset of action and its short
duration of action in the brain. An individual who uses heroin multiple
times per day subjects his or her brain and body to marked, rapid fluctuations
as the opiate effects come and go. These fluctuations can disrupt a number
of important bodily functions. Because heroin is illegal, addicted persons
often become part of a volatile drug-using street culture characterized
by hustling and crimes for profit.
Methadone and LAAM have far more gradual onsets of action than heroin,
and as a result, patients stabilized on these medications do not experience
any rush. In addition, both medications wear off much more slowly than
heroin, so there is no sudden crash, and the brain and body are not exposed
to the marked fluctuations seen with heroin use. Maintenance treatment
with methadone or LAAM markedly reduces the desire for heroin. If an individual
maintained on adequate, regular doses of methadone (once a day) or LAAM
(several times per week) tries to take heroin, the euphoric effects of
heroin will be significantly blocked. According to research, patients
undergoing maintenance treatment do not suffer the medical abnormalities
and behavioral destabilization that rapid fluctuations in drug levels
cause in heroin addicts.
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