TABLE 5.1 Duration of Addiction Treatment

Treatment Setting

Duration

Detoxification/stabilization (if necessary)

3–5 days

Inpatient, hospital-based programs

7–11 days

Residential, non-hospital programs

30–90 days

Therapeutic community programs

6 months–2 years

Outpatient, abstinence-oriented programs

30–120 days

Intensive outpatient

Begin at full or half days 5 times per week for one month, gradually decreasing

Aftercare (biweekly or monthly group meetings)

2 years

Maintenance treatments (e.g., methadone)

Years–lifetime

 

SOURCE: McLellan et al. (1997).

Decisions about treatment setting ideally take into account the overall status of the patient, and much work has been done to help guide such decisions. For example, the American Society of Addiction Medicine recently published a second edition of its Patient Placement Criteria (1997) which presents separate guidelines for adults and adolescents and defines five levels of service for each: early intervention, outpatient services, intensive outpatient/partial hospitalization services, residential/inpatient services, and medically managed intensive inpatient services. Table 5.1 summarizes the average length of treatment in various settings.

The American Psychiatric Association (1995) 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. For example, the Addiction Severity Index (ASI) was developed by McLellan and his colleagues (1980). The ASI assesses seven areas, including medical, employment and legal status, use of alcohol or other drugs, family-social interactions, and psychiatric status. The ASI has been shown to be reliable and valid for measuring severity of addiction and for tracking improvement during treatment.

Alcoholics Anonymous (AA), probably the best known approach to alcohol addiction, is a common component of aftercare for many patients, and is believed by many to be highly effective for individuals who are motivated to follow its 12-step program. However, AA considers itself a "fellowship" rather than a treatment program, and there are no objective studies of its effectiveness for individuals who voluntarily participate. The AA model has been applied to other drugs with the formation of Narcotics Anonymous (NA) groups for people with problems with drugs other than alcohol. The only two controlled studies of AA, which were published many years ago (Brandsma et al., 1980; Ditman and Crawford, 1966), found no evidence that AA improved outcomes for participants who were required to attend AA meetings by the criminal justice system. Some controlled studies, although not specifically focused on AA, have included



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