Principles That Make Substance Abuse Treatment Work

Addiction is a complex but treatable disease that affects brain function and behavior. 

Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence, and despite the potentially devastating consequences that come with relapse.  It’s critical the provider has an EHR that allows them to track and measure data for these clients.

No single treatment is appropriate for everyone. 

Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual’s particular needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. For treatment to work, the plan of service should be outcome driven and measurable.

Treatment needs to be readily available. 

Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.  

Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. 

To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.  The only way of effectively managing a patient’s history through the use of software that is based on outcome measurement.

Remaining in treatment for an adequate period of time is critical. 

The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use, and that the best outcomes occur with a longer duration of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment. Different than using paper for plan development, an electronic system allows for more patient participation in the process of change.

Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment.   

Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.

Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. 

Methadone, buprenorphine, and naltrexone (including a new long-acting formulation) are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (available as patches, gum, lozenges, or nasal spray) or an oral medication (such as bupropion or varenicline) can be an effective component of treatment when part of a comprehensive behavioral treatment program.

An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. 

A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person’s changing needs. To accomplish moving treatment forward, the software must allow for constant change to the treatment plan.  

Many drug-addicted individuals also have other mental disorders. 

Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the others. And when these problems co-occur, treatment should address all issues, including the use of medications, as appropriate.

Medically assisted detoxification is only the first stage of addiction treatment, and by itself does little to change long-term drug abuse. 

Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment. Detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement.

Treatment does not need to be voluntary to be effective. 

Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.

Drug use during treatment must be monitored continuously, as lapses during treatment do occur. 

Knowing their drug use is being monitored can be a powerful incentive for patients, and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.

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