percent to 60 percent of hypertension and 60 to 80 percent of asthma patients needing to be retreated within a year.

The comparability of these data argue that addiction is similar to these three common medical illnesses in that they all can be treated successfully in many patients, but none can be cured and all four often require retreatment. Yet, there are important differences between addiction and these other illnesses in the perception of the public, insurance companies, and physicians. Few would argue that retreatment for diabetes, hypertension, or asthma indicates treatment failure, or that re-treatment should be withheld from or denied to these patients when they relapse and their symptoms reoccur. Yet such an argument is commonly made about addiction.

Similar to the treatment of many illnesses, addiction treatment involves three major stages—detoxification (or acute stabilization), rehabilitation, and follow-up care (McLellan et al., 1997). For all addictive disorders, the initial treatment goal is to help the person stop using alcohol, nicotine, cocaine, heroin, or other drugs and to begin to address the person's physiological, emotional, and motivational status. Detoxification can be accomplished in a variety of ways, depending on the drug(s) involved. 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. Participation in support groups is also a common element of the rehabilitation phase. Follow-up or aftercare is the final phase of treatment for addiction. Aftercare varies considerably in terms of length and frequency of interventions, but prevention of relapse is the major goal of all aftercare strategies.

Relapse is the single most important target of addiction treatment. Data from clinical and outcomes research have shown that many types of treatment approaches are effective in reducing drug use and improving health, but that long-term abstinence is difficult to achieve (McLellan et al., 1995). McLellan and colleagues also found that the longer a person is in treatment, the more likely the treatment will be successful. A critical period seems to be the early stages of treatment, during which attrition is high. Additionally, the literature review provided a strong indication that treatment programs offering a greater variety of services (e.g., counseling, job training, housing assistance, and other services) targeted to an individual's specific problems tend to be most effective.

Despite the general effectiveness of addiction treatment, there is tremendous variation in the types of services offered, and considerable variation in the amount of information available regarding the effectiveness of the major types of treatment programs or any specific individual programs. In part, the variety reflects different approaches that have developed over time to address addiction



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