Dispelling the Myths About Addiction Strategies to Increase Understanding and Strengthen Research (1997) / Chapter Skim
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5 Treating Addictive Disorders
5 Treating Addictive Disorders
Pages 73-94
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From page 73... ...
Treatment effectiveness for addiction was defined as a 50 percent reduction in drug taking after six months. The literature reviewed showed treatment for alcoholism to be successful for 40 percent to 70 percent of patients; success rates for cocaine addiction were 50 percent to 60 percent, opioids 50 percent to 80 percent, and nicotine 20 percent to 40 percent.
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From page 74... ...
For example, treatment of alcoholism usually requires complete abstinence from drinking, but treatment of heroin addiction often utilizes methadone as a substitute to achieve a gradual withdrawal and detoxification. The rehabilitation phase of treatment continues the treatment components utilized initially, but can include additional components, such as education about the harmful effects of drugs and ways to avoid relapse, as well as behavioral or other types of therapy.
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From page 75... ...
TREATMENTS FOR ALCOHOL AND COCAINE ADDICTION Treatment Setting One of the variables in addiction treatment that is the subject of considerable research is the setting in which the treatment occurs. In general, these settings include inpatient versus outpatient settings, but outpatient settings also vary in their intensity and range from regular visits to a clinic to prolonged participation in day hospital programs.
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From page 76... ...
has published a set of clinical practice guidelines which address treatment issues for alcohol and other drug problems. Addiction severity measures have also been developed to help guide treatment decisions.
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From page 77... ...
These programs usually provide intensive treatment, lasting 3 to 6 weeks, and patients help develop their own treatment plans patterned on the 12-step recovery model of AA and NA. Therapeutic communities are considered another type of residential treatment, but include additional elements to address the multiple problems commonly associated with illegal drugs such as unemployment, criminal justice involvement, and other circumstances.
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From page 78... ...
Cocaine addiction can be initially treated taking an approach more focused on stabilization in an outpatient setting. One study comparing inpatient versus outpatient treatment for cocaine addiction found differences in completion of treatment between the groups, 89 percent completed inpatient versus 54 percent completed outpatient treatment, but a follow-up at 7 months revealed no differences between the groups in abstinence from cocaine (Alterman et al., 1994~.
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From page 79... ...
Behavioral marital therapy emphasizes improving communication and problem solving between spouses and increasing praise and other positive interactions. Brief interventions, which may be provided by addiction specialists but are often provided by internists or other health care professionals in primary care settings, generally consist of the professional providing objective information about the patient's individual drinking problem, giving the patient the opportunity to take responsibility for changing his or her behavior, and one or two counseling sessions.
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From page 80... ...
Although more research has been done examining psychosocial treatments for alcohol addiction, recent studies indicate differences between various therapies in cocaine treatment. For example, one study compared cocaine-addicted patients randomly assigned to either behavioral counseling, based on the community reinforcement model, or drug abuse counseling, based on a disease model (Higgins et al., 1993~.
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From page 81... ...
When naltrexone was used in conjunction with behavioral therapy over a 3-month period, patients receiving the drug after discharge from inpatient treatment were half as likely to relapse compared to those receiving a placebo. Patients receiving naltrexone generally reported fewer drinking days, fewer drinks per session, and lowered craving scores (O'Malley et al., 1996~.
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From page 82... ...
This research, often referred to as patient-treatment matching, is aimed at providing an empirically derived knowledge base to improve patient placement criteria and treatment outcomes (McLellan and Alterman, 1991~. One of the largest of these studies, Project MATCH, was published in 1997 and involved an 8-year, multisite trial of alcoholism treatment that assessed three behavioral treatment conditions and 10 patient factors (NIAAA, 1997a)
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From page 83... ...
The four major types of publicly funded treatment programs for opioid addiction are detoxification, outpatient methadone maintenance, therapeutic communities, and outpatient drug-free programs (Anglin and Hser, 1992~. Addiction research has tended to focus on the effectiveness of these publicly funded programs, especially for individuals addicted to heroin (see also Appendix E)
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From page 84... ...
New Pharmacotherapies for Opioid Addiction Naltrexone (Revia_, formerly Trexan_) , a selective opioid antagonist which was approved for the treatment of narcotic dependence in 1984, has been found to prevent relapse to opioid dependence in patients who are very highly motivated, such as parolees and health care professionals.
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From page 85... ...
SMOKING CESSATION PROGRAMS Much of this chapter has examined treatment for opioid or cocaine addiction and alcoholism. It is useful, however, to consider briefly the application of various treatment strategies for nicotine addiction.
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From page 86... ...
The gum provides a slow release of nicotine, totaling 2 mg or 4 mg per piece (Haxby, 1995~. Nicotine chewing gum has been thoroughly studied, and several meta-analyses clearly demonstrate its modest but statistically significant short-term effectiveness, especially when used in conjunction with intensive behavioral interventions (Cepeda-Benito, 1993; Haxby, 1995~.
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From page 87... ...
A preliminary study suggests that adding nicotine gum use to active patch use can increase abstinence rates among people who smoke 10 cigarettes or more a day a statistically significant increase up to 6 months (Kornitzer et al., 1995~. For those who used both the patch and gum, the abstinence rate was 27 percent after 6 months and 18 percent after 1 year (Kornitzer et al., 1995~.
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From page 88... ...
Examination of the relationship between alcohol abuse and the abuse of cocaine, nicotine, opioids, and other drugs · Examination of the behavioral consequences of the interaction of alcohol with other drugs of abuse and evaluation of the effect of medications for the treatment of codependence problems Nicotine · Evaluation of optimal combination of pharmacotherapy (with one drug or multiple drugs) and behavioral intervention for relapse prevention in humans · Development of an acceptable nicotine antagonist for motivated smokers who have not succeeded with nicotine replacement therapy · Further development of patient-treatment matching, especially treatments targeted at those subpopulations where smoking is most prevalent (e.g., smoking and alcohol, smoking and use of other psychoactive drugs, smoking in chronic psychotic patients)
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From page 89... ...
1995. Practice Guidelines for the Treatment of Patients with Substance Abuse Disorders: Alcohol, Cocaine, Opioids.
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1993. Effectiveness of nicotine patch and nicotine gum as individual versus combined treatments for tobacco withdrawal symptoms.
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1990. Inpatient treatment of employed alcoholics: A randomized clinical trial on Hazelden-type and traditional treatment.
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From page 92... ...
1997. Can the outcomes research literature inform the search for quality indicators in substance abuse treatment?
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From page 93... ...
In: Galanter M, Kleber HD, eds. Textbook of Substance Abuse Treatment.
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