Drug Treatment - Types Of Treatment

The treatment that a recovering drug addict receives depends on the types of drugs to which they are addicted. Regardless of the substance they are addicted to most treatment programs involve some form of rehabilitation ("rehab"). For many types of addiction rehab is the only form of treatment that is needed. However those who are addicted to opiates typically must undergo a period of detoxification ("detox") before rehab can begin. In some cases opiate addicts are given opioid substitutes to help them with their addiction in addition to or instead of rehab.

Detox

Individuals addicted to opium-based drugs must usually undergo medical detoxification in an outpatient facility, a residential center, or a hospital. Medical help, including sedation, is provided to manage the painful physical and psychic symptoms of withdrawal. Counseling is always available as well; in many so-called detox centers, group therapy is also available. NIDA, however, describes detoxification as a precursor to treatment (in

TABLE 8.3
Substance abuse treatment admissions, by sex, race/ethnicity, and age group, 1992-2002
SOURCE: "Table 2.9a. Admissions by Sex, Race/Ethnicity, and Age at Admission: TEDS 1992-2002 Number," in Treatment Episode Data Sets (TEDS) 1992-2002, Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, September 2004, http://www.dasis.samhsa.gov/teds02/2002_teds_rpt.pdf (accessed March 31, 2005)

Sex, race/ethnicity, and age at admission	1992	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002
Total	1,543,758	1,611,715	1,665,331	1,675,380	1,639,064	1,607,957	1,712,268	1,729,878	1,778,352	1,788,646	1,879,999
Sex
Male	1,104,492	1,147,004	1,182,286	1,179,563	1,151,527	1,128,154	1,202,608	1,215,478	1,241,677	1,246,642	1,313,303
Female	430,830	455,205	473,884	488,715	481,191	474,350	502,961	508,327	531,542	538,321	565,053
No. of admissions	1,543,758	1,611,715	1,665,331	1,675,380	1,639,064	1,607,957	1,712,268	1,729,878	1,778,352	1,788,646	1,879,999
Race/ethnicity
White (non-Hispanic)	923,856	939,805	963,257	981,359	973,808	948,992	1,004,115	1,011,066	1,028,144	1,048,230	1,097,962
Black (non-Hispanic)	401,478	431,065	447,945	443,964	418,514	402,619	419,784	415,289	437,320	429,409	446,946
Hispanic	152,488	168,521	181,168	178,269	169,285	173,347	191,484	202,865	211,483	212,424	236,652
American Indian/ Alaska Native	38,531	39,402	38,404	37,704	40,082	38,333	40,511	40,137	40,407	39,373	39,463
Asian/Pacific Islander	7,738	9,010	9,873	9,870	10,197	10,893	11,515	13,619	14,859	14,298	16,552
Other	9,557	11,031	12,896	13,193	16,606	18,263	20,351	24,161	28,588	26,936	27,620
No. of admissions	3,060,111	3,190,508	3,296,105	3,316,676	3,240,753	3,171,248	3,368,162	3,399,235	3,495,706	3,518,082	3,701,022
Age at admission
Under 12 years	3,926	3,438	3,211	3,616	3,469	3,704	3,390	3,300	3,371	2,952	3,030
12 to 17 years	94,089	95,266	109,122	122,909	129,858	131,194	139,129	137,783	138,660	146,012	156,367
18 to 24 years	239,761	231,869	232,063	230,645	219,406	220,714	245,508	258,551	278,759	295,782	318,758
25 to 34 years	612,220	629,632	628,260	603,148	555,300	516,346	517,297	489,763	478,685	463,098	469,970
35 to 44 years	403,150	450,682	482,401	499,650	507,067	506,624	549,754	561,144	577,897	569,573	583,820
45 to 54 years	128,436	140,865	151,320	159,111	167,899	173,335	197,211	213,867	234,880	247,184	277,512
55 to 64 years	41,076	41,133	41,052	40,390	41,377	40,736	44,096	46,320	48,833	48,732	55,492
65 years and older	13,494	13,691	12,967	11,938	11,535	11,381	11,611	11,484	11,937	11,098	11,054
No. of admissions	4,541,693	4,742,260	4,902,482	4,935,755	4,823,752	4,723,165	5,020,451	5,063,643	5,207,958	5,242,683	5,510,479

Principles of Drug Addiction Treatment, cited above), because actual treatment cannot begin in earnest until the individual's body has been cleared of the drug and a certain equilibrium has been established. A program of rehabilitation usually follows detoxification.

Rehabilitation

Rehab has many forms, but it is always designed to change the behavior of the drug abuser. Changed behavior—achieving independence of drugs or alcohol—requires understanding of the circumstances that led to dependence, faith that the individual can succeed, and changes in lifestyle so that the individual avoids occasions that produced drug-using behavior. Individual counseling, interaction with support groups, and formal education are used in combination with close supervision, incentives, and disincentives (such as, for instance, termination of probation). Certain individuals require a new socialization, achieved by living for an extended time in a structured and supportive environment in which new life-skills can be acquired. Treatment may involve guiding the individual to seek help from other social agencies (as shown in Figure 8.1) to reorder his or her life.

Individuals, of course, may be mentally ill and will then receive, as part of drug rehabilitation, mental health services in outpatient or hospital settings.

Most treatment, as will be discussed below, takes place in outpatient settings, with the individual reporting daily, weekly, or less frequently for periodic treatment and assessment.

OPIOID SUBSTITUTE PROGRAMS.

Heroin addicts and those habituated to other opium-based substances follow the treatment programs already described but may, in addition, be prescribed what are known as opioid substitutes. The best known of these is methadone, known as an "agonist," a chemical substance that activates brain receptors. In the case of methadone, these are the same receptors that respond to heroin. Methadone was approved for use in 1972. While heroin addiction disrupts many physiological functions, methadone normalizes those functions. Many studies have shown methadone to be effective; many thousands lead normal lives using this heroin substitute.

LAAM (levo-alpha-acetylmethadol), approved in 1993, is another agonist used in treating drug dependency. While methadone must be taken daily, LAAM can be taken three times a week. Use of LAAM and methadone is not without risk. It is possible to become dependant on them just as it is with heroin and other opioids. However clinical experience with both methadone and LAAM indicates that these medications have a much lower potential for abuse than heroin.

Naltrexone is an "antagonist," a chemical substance that reduces the effect of another chemical substance on the body. Naltrexone blocks the effect of heroin on the brain's receptors and can reduce involuntary compulsive drug craving. It can be prescribed by physicians and is effective both against alcohol dependency and in detoxification. Buprenorphine, which was approved for use by the Food and Drug Administration in 2002, acts as an agonist at lower doses and as an antagonist (a chemical substance that reduces the effect of another chemical substance on the body) at higher doses ("Subutex and Suboxone Approved to Treat Opiate Dependence," FDA Talk Paper, T02-38, October 2, 2002, http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01165.html).

Distribution of Patients

The great majority of patients undergoing treatment in 2003 were receiving outpatient care, 89% of some 1.1 million patients on March 31 of that year. (See Table 8.2.) Of the remainder, 1% received hospital inpatient treatment, and 10% were in residential facilities. Of those under outpatient treatment but not in detox, the majority were receiving what SAMHSA labels regular, or non-intensive, treatment.

Of the total treatment population, 27,898 individuals (2.6% of all patients) were undergoing detox, most in outpatient settings (11,770), the rest in residential facilities (9,061) and hospitals (7,067). Among all patients under treatment, 213,119 (20%) were receiving an opioid substitute; the vast majority of these were on methadone.

About a fifth were being treated for alcohol abuse only, and a third were being treated for drug abuse only. The largest category (47%) was treated for both drug and alcohol abuse. For a small portion of the patients, SAMHSA's survey did not capture the type of treatment (drugs versus alcohol) they were receiving.

Two-thirds of patients were in facilities that specialized in substance abuse, 23% in facilities that combined substance abuse with health care, and 5% were in facilities specializing in mental health treatment.

SAMHSA's N-SSATS survey in 2003 covered 13,623 facilities, with a median of forty clients per facility. Outpatient facilities had a median of forty-five clients, while residential treatment facilities had a median of eighteen. Hospitals had the smallest median number of clients at nine.