. "Appendix D: Commissioned Paper: The Treatment of Addiction: What Can Research Offer Practice?." Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment. Washington, DC: The National Academies Press, 1998.
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essary to produce sustained benefits. In part this is due to disagreement regarding the etiology and course of the addiction syndrome. These etiological theories include a genetic predisposition, an acquired metabolic abnormality, learned negative behavioral patterns, self medication of underlying psychiatric or physical medical problems, and lack of family and community support for positive function. For this reason, there is an equally wide range of treatment methods that have been applied to address these etiological and predisposing factors and to provide continuing support for the targeted behavioral changes. These have included such diverse elements as psychotropic medications to relieve underlying psychiatric problems, "anti-craving" medications to relieve alcohol and drug craving, acupuncture to correct acquired metabolic imbalances, educational seminars, films and group sessions to correct false impressions about alcohol and drug use, group and individual counseling and therapy sessions to provide insight, guidance and support for behavioral changes, and peer help groups (AA/ NA/CA) to provide continued support for the behavioral changes thought to be important for sustaining improvement.
These rehabilitation methods have been traditionally provided in two types of settings—inpatient and outpatient. At this writing, inpatient rehabilitation programs can be divided into three general categories (Hubbard et al., 1989, 1997):
Inpatient hospital-based treatment (now very rare)—from 7 to 11 days.
Nonhospital "residential rehabilitation"—from 30 to 90 days.
Therapeutic Communities—from 6 months to 2 years.
Outpatient forms of treatment (at least abstinence oriented treatments) range from 30 to 120 days (Hubbard et al., 1989, 1997). Many of the more intensive forms of outpatient treatment (Intensive Outpatient, Day-Hospital) begin with full or half-day sessions, five or more times per week for approximately one month. As the rehabilitation progresses the intensity of the treatment reduces to shorter duration sessions (one to two hours) delivered twice weekly to semi-monthly.
Regardless of whether the rehabilitation process is initiated in an inpatient or outpatient setting, most rehabilitation programs recognize the need for some level of continuing involvement with the rehabilitation process. Thus the final part of outpatient rehabilitation is typically called "Continuing Care" or "Aftercare" and includes weekly to monthly group support meetings continuing (in association with parallel activity in self-help groups) for as long as two years (McKay et al., 1998).