Drug treatment is intended to help addicted individuals to stop compulsive drug seeking and use. Treatment can occur in a variety of settings, take many different forms, and last for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment is usually not sufficient. For many, treatment is a long-term process that involves multiple interventions and regular monitoring.
There are a variety of evidence-based approaches to treating addiction. Drug treatment can include behavioural therapy (such as cognitive-behavioural therapy or contingency management), medications, or their combination. The specific type of treatment or combination of treatments will vary depending on the patient’s individual needs and, often, on the types of drugs they use.
Drug addiction treatment can include medications, behavioural therapies, or their combination.
Treatment medications, such as methadone, buprenorphine, and naltrexone (including a new long-acting formulation), are available for individuals addicted to opioids, while nicotine preparations (patches, gum, lozenges, and nasal spray) and the medications varenicline and bupropion are available for individuals addicted to tobacco. Disulfiram, acamprosate, and naltrexone are medications available for treating alcohol dependence,1 which commonly co-occurs with other drug addictions, including addiction to prescription medications.
Treatments for prescription drug abuse tend to be similar to those for illicit drugs that affect the same brain systems. For example, buprenorphine used to treat heroin addiction, can also be used to treat addiction to opioid pain medications. Addiction to prescription stimulants, which affect the same brain systems as illicit stimulants like cocaine, can be treated with behavioural therapies, as there are not yet medications for treating addiction to these types of drugs.
Behavioural therapies can help motivate people to participate in drug treatment, offer strategies for coping with drug cravings, teach ways to avoid drugs and prevent relapse, and help individuals deal with relapse if it occurs. Behavioural therapies can also help people improve communication, relationship, and parenting skills, as well as family dynamics.
Many treatment programs employ both individual and group therapies. Group therapy can provide social reinforcement and help enforce behavioural contingencies that promote abstinence and a non-drug-using lifestyle. Some of the more established behavioural treatments, such as contingency management and cognitive-behavioural therapy, are also being adapted for group settings to improve efficiency and cost-effectiveness. However, particularly in adolescents, there can also be a danger of unintended harmful (or iatrogenic) effects of group treatment—sometimes group members (especially groups of highly delinquent youth) can reinforce drug use and thereby derail the purpose of the therapy. Thus, trained counsellors should be aware of and monitor for such effects.
Because they work on different aspects of addiction, combinations of behavioural therapies and medications (when available) generally appear to be more effective than either approach used alone.
Finally, people who are addicted to drugs often suffer from other health (e.g., depression, HIV), occupational, legal, familial, and social problems that should be addressed concurrently. The best programs provide a combination of therapies and other services to meet an individual patient’s needs. Psychoactive medications, such as antidepressants, anti-anxiety agents, mood stabilizers, and antipsychotic medications, may be critical for treatment success when patients have co-occurring mental disorders such as depression, anxiety disorders (including post-traumatic stress disorder), bipolar disorder, or schizophrenia. In addition, most people with severe addiction abuse multiple drugs and require treatment for all substances abused.
Treatment for drug abuse and addiction is delivered in many different settings using a variety of behavioural and pharmacological approaches.
1Another drug, topiramate, has also shown promise in studies and is sometimes prescribed (off-label) for this purpose although it has not received FDA approval as a treatment for alcohol dependence.