Pathways of Addiction Opportunities in Drug Abuse Research (1996) / Chapter Skim
Currently Skimming:
8. Treatment
8. Treatment
Pages 192-221
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 192... ...
The remainder of the chapter discusses opportunities for future research on medications development, treatment of HIV–infected drug abusers, matching patients to treatment options, treatment of patients with cooccurring psychiatric disorders and drug abuse, and treatment of drug abuse in special populations. OVERVIEW OF DRUG ABUSE TREATMENT Treatment is clearly indicated for individuals diagnosed with drug dependence, the most serious of the three levels of drug consumption -- use, abuse, and dependence (see definitions in Chapter 1)
|
From page 193... ...
For example, the National Drug and Alcoholism Treatment Unit Survey (NDATUS) reported that almost 1.0 million people in 1993 were in private and public drug abuse treatment programs; approximately 20 percent of those in treatment were enrolled mainly for illicit drug abuse, 45 percent for alcohol, and 35 percent for combined alcohol and other drug dependencies (SAMHSA, 1995a)
|
From page 194... ...
. Structured treatment programs are generally classified according to four major treatment modalities: methadone maintenance, outpatient drug-free programs, therapeutic communities, and chemical dependency programs.
|
From page 195... ...
. Opiate antagonist medications work by binding to the opioid receptor site, preventing receptor activation by the abused drug and thereby blocking the drug's euphorigenic and dependence-producing effects.
|
From page 196... ...
. Two prospective studies done in methadone programs using random assignment and a range of measures have shown that these psychotherapies can provide additional benefits to patients with moderate to high levels of psychiatric symptoms (Woody et al., 1984, 1995b)
|
From page 197... ...
The final study, which is still in progress, is the Drug Abuse Treatment Outcome Study (DATOS)
|
From page 198... ...
. This study, the first cost–benefit study to include the benefit of lower health care utilization, was undertaken by the State of California on 3,000 clients discharged from treatment programs in 1992.
|
From page 199... ...
. Investigators found treatment programs to be far more cost-effective than a range of drug control strategies in reducing cocaine use.
|
From page 200... ...
The RAND study compared treatment (a demand control strategy) and three supply control strategies: source country control, interdiction, and domestic enforcement.
|
From page 201... ...
. Work is currently under way to modify them to improve the distinctions between primary psychiatric disorders and drug-produced psychiatric syndromes in order to further improve treatment (D.
|
From page 202... ...
. Additionally, research in medications development, HIV/AIDS and injection drug use, treating patients with co-occurring psychiatric disorders and drug abuse, and treating special populations of drug abusers is critical to fully meet the treatment needs of this population and to reduce the associated social and health consequences to society.
|
From page 203... ...
and that the reinforcing effects of opiates and cocaine can be reduced by medications that alter their ability to activate the brain's reward system, there has not been a medication developed to treat cocaine addiction. Although recent work has provided information on the molecular basis of acute cocaine action and on the several neurotransmitter systems, including those mediated by dopamine, serotonin, and norepinephrine, that play a role in cocaine's effect on the brain reward system, there are gaps in knowledge about cocaine addiction.
|
From page 204... ...
, rather, it highlights research opportunities unique to the treatment of HIV-infected drug abusers and focuses specifically on medical complications and health care delivery issues. Medical Complications Although injection drug users (IDUs)
|
From page 205... ...
Health Care Services As research continues to address the best treatment modalities for HIV-infected drug abusers, studies are needed on the issues of access and utilization of treatment that are unique to that population. Research has established that drug abuse treatment is associated with a reduction in HIV transmission or related risk behaviors (see Chapter 7)
|
From page 206... ...
When HIV-infected drug abusers enter drug abuse treatment programs, they typically are referred to medical clinics for diagnosis and treatment of HIV-related medical problems (Umbricht-Schneiter et al., 1994)
|
From page 207... ...
Studies demonstrating the cost-effectiveness of the delivery of primary care through drug treatment programs might encourage legislators and public health agencies to provide funding for the expansion of services, including outreach to the community to encourage drug abusers to seek treatment. It is also important for the clinician outside of the drug abuse treatment system to be familiar with the full spectrum of HIVrelated diseases and medical complications in this population.
|
From page 208... ...
Patients who have psychiatric, medical, family, and/or legal problems are likely to need highly trained staff with special training in complex interventions. Two studies of matching patients strictly with drug dependencies to treatment settings that addressed particular needs demonstrated better treatment outcomes than treatment settings that did not address specific needs (McLellan et al., 1983, in press, b)
|
From page 209... ...
. In some cases, state guidelines require separate licensing for drug abuse and mental health services and separate administration of drug abuse treatment from psychiatric, medical, family, and other related services.
|
From page 210... ...
Additional study of persistent drug-produced psychiatric disorders (e.g., potential long-term effects of dependence on stimulants such as cocaine) is important both in prevention and for the design and implementation of treatment programs.
|
From page 211... ...
drug abusers often abuse multiple drugs, studies are needed to determine the interactions among drugs of abuse, medications used to treat drug dependence, and medications used to treat comorbid psychiatric and medical disorders. For example, a medication intended to prevent relapse to cocaine dependence should be tested for adverse consequences when used in combination with alcohol or opiates since these drugs are commonly used together.
|
From page 212... ...
These complex issues indicate that psychiatric assessment and treatment constitute a particularly important aspect of drug abuse treatment for women. Few studies have been done to examine the effect of integrating psychiatric treatment into the ongoing services of programs that treat drug-abusing women.
|
From page 213... ...
A recent survey of 294 drug treatment programs in five cities revealed that the majority of programs (70–83 percent) accepted pregnant women.
|
From page 214... ...
. Although there are extensive studies of drug-involved offenders who are treated effectively in community settings, there is a dearth of information about drug treatment programs in prisons or about the best means of treating drug abusers in these settings.
|
From page 215... ...
The committee recommends that the appropriate federal and pri vate agencies continue to support research to improve and evaluate the effectiveness of drug abuse treatment. This includes studies on optimal strategies for matching patients to the most appropriate treatment modalities; development of medications for the treatment of drug abuse and dependence; the efficacy of pharmacotherapies and psychosocial therapies to treat individuals with co-occurring psychiatric disorders and drug abuse; the natural history of HIV infection among drug users and effective models of health care delivery for HIV-infected drug abusers; and the efficacy of treat ment programs designed toward addressing the needs of special populations (i.e., women, adolescents, and prisoners)
|
From page 216... ...
Journal of Substance Abuse Treatment 8:269–275.
|
From page 217... ...
In: Galanter M, Kleber HD, eds. The American Psychiatric Press Textbook of Substance Abuse Treatment.
|
From page 218... ...
1983. Increased effectiveness of substance abuse treatment: A prospective study of patient treatment "matching." Jour nal of Nervous and Mental Disease 171:597–605.
|
From page 219... ...
1993. Relapse prevention strategies in outpatient substance abuse treatment.
|
From page 220... ...
1992. Clinical manifestations and predictors of disease progression in drug users with human immunodeficiency virus infection.
|
From page 221... ...
1. Washington, DC: American Psychiatric Association Press.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.