DRUG

ADDICTION

Submitted To:
Mohammed Azhar Pervaiz

Date: November 16, 2007

 Drugs Addiction
Drug addiction is a condition characterized by compulsive drug intake, craving and
seeking, despite what the majority of society may perceive as the negative consequences
associated with drug use.
Although being addicted implies drug dependence, it is possible to be dependent on a
drug without being addicted. People that take drugs to treat diseases and disorders,
which interfere with their ability to function, may experience improvement of their
condition.
Such persons are dependent on the drug, but are not addicted. One is addicted, rather
than merely dependent, if one exhibits compulsive behavior towards the drug and has
difficulty quitting it.
To qualify as being dependent a person must
Take a drug regularly
Experience unpleasant symptoms if discontinued, which makes stopping difficult.
Substance abuse can occur with or without dependency, and with or without addiction.
Substance abuse is any use of a substance, which causes more harm than good.

History Of Drugs:
The phenomenon of drug addiction has occurred to some degree throughout recorded
history, though modern agricultural practices, improvements in access to drugs,
advancements in biochemistry, and dramatic increases in the recommendation of drug
usage by clinical practitioners have exacerbated the problem significantly in the 20th
century. Improved means of active biological agent manufacture and the introduction of
synthetic compounds, such as methamphetamine are also factors contributing to drug
addiction.

Components Of Drugs:
Drug addiction has two components: physical dependency, and psychological
dependency. Physical dependency occurs when a drug has been used habitually and the
body has become accustomed to its effects. The person must then continue to use the
drug in order to feel normal, or its absence will trigger the symptoms of withdrawal.
Psychological dependency occurs when a drug has been used habitually and the mind
has become emotionally reliant on its effects, either to elicit pleasure or relieve pain, and
does not feel capable of functioning without it. Its absence produces intense cravings,
which are often brought on or magnified by stress. A dependent person may have either
aspects of dependency or both.
"Chipping" is also a term used to describe a pattern of drug use in which the user is not
physically dependent and sustains 'controlled use' of a drug. This is done by avoiding
influences that reinforce dependence, such that the drug is used for relaxation and not for
escape. This is similar to the medical term 'recreational substance use'.

Addictive Nature:
The addictive nature of drugs varies from substance to substance, and from individual to
individual. Drugs such as codeine or alcohol, for instance, typically require many more
exposures to addict their users than drugs such as heroin or cocaine. Likewise, a person
who is psychologically or genetically predisposed to addiction is much more likely to
suffer from it.
Although dependency on hallucinogens like LSD ("acid") and psilocybin (key hallucinogen
in "magic mushrooms") is listed as Substance-Related Disorder in the DSM-IV, most
psychologists do not classify them as addictive drugs. Experts on addiction say that the
use of LSD and psilocybin causes neither psychological nor physical dependency. Many
users report feeling less desire to use these drugs after every use.

The Basis For Addiction:

There is a growing viewpoint that drug addiction is a form of dysfunctional learning. Drugs
of abuse take over the neurological circuitry involved in motivation and reward. This leads
to aberrant learning. Because of this, drug-associated cues can trigger a desire to use, as
well as unconscious or compulsive drug-seeking behavior, with the sense that voluntary
control over drug use is lost.
The stages of problematic use could be defined as preoccupation/anticipation,
binge/intoxication, and withdrawal/negative effect.[3] As drugs activate neuronal
pathways in the brain, they get 'laid down' stronger and stronger with each use. These
pathways also activate faster with each use. The quicker the effect, or 'high', the stronger
the dysfunctional learning. In addition, objects, people, or places also seem to be strongly
associated with the drug experience, making them 'triggers' to 'cravings' and increase
the chances of further use. Those that favor the biological models of addiction see these
neuron-chemical changes in the brain as evidence that addiction is a disease, though
research has shown that this learned behavior can be unlearned. Unfortunately,
substance abuse also inhibits further learning, meaning continued use makes unlearning
more challenging.
Abused drugs can also modulate long-term potentiation (LTP) and long-term depression
(LTD) in neuronal circuits associated with the addiction process, suggesting a way for the
behavioral consequences of drug-taking to become reinforced by learning mechanisms.
[4] Effectively assessing where an individual is in addiction and tailoring treatment to this
would make treatment outcomes more effective. This may be why there have been no
outstanding results in terms of treatments for addiction with the most significant factor in
recovery being the user therapist relationship. In addition to determining where someone
is in terms of addiction, indications as to where they are in their current cycle of use:
Crash, withdrawal or extinction would also inform appropriate treatment interventions.
Animal studies have shown that drug availability (over and above the actual effects of the
substance) are associated with stimuli exposure to objects associated with use; these
trigger the release of adrenaline (which causes "fight or flight" response). The excitation
can be perceived as a 'need' to use.
Glutamate, Dopamine, and Serotonin have long been associated with highly dependent
addictions are well established as key to the compulsive behavior related to cocaine and
amphetamine use, Nor epinephrine, GABA& NMDA are also very important in terms of
learning and 'Addiction' With GABA seeming strong in terms of alcohol abuse and the
corresponding crash.
Types Of Drugs:
Almost all drugs have the potential for addiction and abuse, from caffeine to prescription
medication. However, the majority of non-alcohol-related drug problems are due to use of
the substances listed below. These drugs affect users' brains and bodies in different ways,
producing symptoms of intoxication and abuse that are unique to each substance. There
are many types of drugs but some are very important and known drugs which are
harmful for everyone.

1- Tobacco

2- Alcohol

3- Cannabis

4- Heroin

5- Cocaine
Now we’ll explain the types of drugs.

Tobacco
Tobacco is the dried leaves of the
Tobacco plant. It grows in many
parts of the world. Tobacco can be
consumed in the form of cigarettes,
cigars, pipes, chewing, or sniffed in
the form of snuff.
Approximately 30% of people aged
16 or over regularly smoke. Most
Tobacco is smoked in the form of
cigarettes.
Cigarette smoke contains various substances such as nicotine, tar, carbon monoxide and
other gases. Some of these substances are absorbed by the lungs. Nicotine is the active
addictive of cigarette smoking as it builds up in the body. The effects decline soon after
stopping. As a consequence the user may be left wanting more after only a short time.
One or two cigarettes may increase blood pressure and heart rate. The appetite will be
suppressed and the skins temperature will lower. Smokers can use cigarettes to relieve
tension, boredom, and tiredness. First time users may feel dizzy and slightly sick.
The more you smoke the more you are at risk from heart disease, lug cancer, blood clots,
heart attacks, bronchitis and many, many more serious diseases. When the smoker stops
they may experience withdrawal effects such as restlessness, irritability, and depression.
Physical and psychological dependence often occurs with regular use. During pregnancy
smoking should be avoided as it leads to an increased risk of miscarriage and smaller
baby weight.

Effects:
Tobacco contributes to at least 100,000 deaths in the UK. A quarter of young male
smokers will die 'before their time' due to smoking related diseases. Smoking tobacco can
cause irreversible damage to the lungs, however if no irreversible damage has occurred,
then the lungs will repair and clean themselves leading to normal health and lifespan.
Women who smoke and take oral contraceptives are 10 times more likely to suffer heart
and circulatory diseases than non smoking women. Passive smoking affects non smokers
who are at risk of developing smoking related diseases if in regular contact with tobacco
smoke.

Legal Status:
Selling any tobacco product to those under 16 is illegal and can result in a fine of up to
£1000. There is no restriction on the possession and smoking of tobacco, though there
are bans on most forms of public transport and in some public places. The commercial
manufacture of tobacco requires a license, but anyone can grow tobacco for their own
use.

Alcohol
Alcoholic drinks consist of ethyl or
ethanol alcohol and water. Alcohol is
produced by the fermentation of
grains or vegetables. Beer contains
about 1 part alcohol to 20 parts
water, wine is 2-4 times as strong as
beer and spirits are even stronger.
Beer and wine drinking almost
certainly predate recorded history
and are an integral part of everyday
life in Britain.
Alcohol is absorbed into the bloodstream and starts to take effect within five to ten
minutes. Effects may last from one to several hours depending on dose. The effects can
vary according to body size and whether food is in the stomach and how much the person
is used to drinking. After the equivalent of drinking two pints of beer most people feel less
inhibited and relaxed. Jovial and merry feelings can occur and getting drunk is a relatively
common event especially in student circles.
The first negative effect most people will experience with alcohol is a hangover consisting
of one, or a variety of symptoms, including a headache caused by dehydration (alcohol
affects the pituitary gland that controls the flow of water released by the body as urine). A
sick and raw feeling of the stomach can occur. Whilst under the influence of alcohol
accidents can happen and alcohol should not be taken before, or while operating
machinery or driving (even if you drank the night before). Larger doses may lead to
depressive and violent behavior. The sex drive may increase but performance may suffer
one form being brewer's droop! Alcohol is packed with calories one gin and tonic contains
the same amount as a bowl of ice cream so consistent use can lead to noticeable weight
gain.

Effects:
For some students alcohol consumption increases without them realizing - this can result
in financial problems, hangovers, affect their ability to concentrate on their studies,
morning lectures are missed and they find themselves having to fit their lifestyle around
their alcohol use. Some of these students may even experience health problems, such as
early gastric and liver damage. Regular drinking of large amounts of alcohol by pregnant
women can harm the fetus. Both physical and psychological dependence may occur with
high levels of use. Follow the link for guidelines from the Health Education Authority about
safe levels of drinking.
Alcohol and other drugs
It is not a good idea to take alcohol with other drugs as it can exaggerate the effect of
those drugs. There are risks of overdosing, becoming unconscious and choking on ones
vomit which can result in death. It is worth remembering that many drug related deaths
occur through mixing alcohol with other drugs.
Cannabis
Cannabis (blow, puff, dope, hash,
grass) is the most commonly used
illegal drug in the UK. It is usually
smoked in the form of resin, a
brown solid mass which is crumbled
and mixed with tobacco to form a
joint or spiff. Alternatively Cannabis
can be taken orally whether raw or
mixed in cakes, fudge etc.

Effects:
The effects of Cannabis can vary from person to person, some users may feel more
talkative, more relaxed, experience a sense of well being and being ‘stoned’ (heightened
perception) often mentally distancing them from their surroundings. Mild hallucinations
and strong feelings of affection may occur. Skunk is a new strain of Cannabis that is
extremely potent causing very strong hallucinogenic experiences.
When smoked Cannabis contains carcinogenic chemicals. If joint is made using Cannabis
and tobacco this will cause even more damage to the lungs. The most common bad
reactions to Cannabis are paranoia, panic attacks, mood swings, sleeping problems, short
term memory loss and reduced concentration which can be dangerous if operating
machinery or driving. Furthermore using Cannabis can result in craving for food which
could lead to noticeable weight gain with continuous use.
Cannabis may bring to the surface in some users emotional problems which my lead to
more severe mental health problems. Heavy users may become de-motivated in life
which can lead to alack of interest in academic matters. Users may begin to change their
lifestyle to fit around taking Cannabis and lose interest in their friends, family and social
affairs.
Like tobacco, long term regular smoking can lead to bronchitis and other lung disease
such as lung cancer. Physical dependence does not occur, although psychological
dependence may.
N.B. Traces of Cannabis can stay in the body for at least a month. This could be an issue if
a user has to take a pre-employment medical exam.

Signs and Symptoms:

The list of signs and symptoms mentioned in various sources for cannabis includes
following symptoms:
• Pleasurable sensation
• Feeling stoned
• Relaxation
• Distorted perception
• Vivid sounds
• Vivid sights
• Dry mouth
• Dry eyes
• Hunger
• Thirst
• Increase laughing
• Poor coordination
• Fear of dying
• Panic attack
• Vomiting
• Red eyes
• Confusion
• Poor driving
• Anxiety
• Panic
• Psychosis

Heroin
Heroin addiction is a serious life
threatening dilemma. It can occur very
quickly among abusers who use heroin on
a regular basis. This is due to the fact that
tolerance develops upon repeated use of
the drug. Users suddenly find that they are
using more and more heroin to achieve the
same high that they originally felt. The
addictive nature of heroin is characterized
by the tolerance a user builds to the drug
as well as constant cravings for heroin.
Heroin activates brain regions that
produce euphoric sensations and physical dependence. Heroin is notorious for its ability
to produce both psychological and physical addiction. Chronic heroin users will
experience withdrawal symptoms when heroin use is discontinued. Heroin overdose is
responsible for the majority of accidental drug related deaths in the U.S.

Symptoms:
• Sweating
• Dry Mouth
• Nausea
• Vomiting
• Increased urination
• Itchy skin
• Suppression of pain
• Slowed breathing
• Skin abscesses
Potential Negative Effects of Heroin:
• Restlessness
• Constipation
• Sweating
• Menstrual irregularities
• Collapsed veins
• Liver disease
• Lowered resistance to infection
• Respiratory failure
• Respiratory illnesses such as pneumonia
• Reduced respiration; breathing difficulties
• Tolerance
• Withdrawal
• Overdose
• Addiction

More About Heroin:

Heroin is an illegal drug processed from morphine, a natural substance that is extracted
from the seedpod of the Asian poppy plant. It is usually white or brown and comes in a
powdered form. Heroin is typically injected, but recent studies have shown that there is a
shift in the way that heroin is being used. More and more people have begun to snort the
drug due to its increased purity and the false idea that snorting will not lead to
dependence.
Heroin has a long history of use and addiction. As far back as 6,000 years ago Sumerian’s
referred to the opium poppy as the "joy plant". Many think that the Arab traders took
opium to China in 7th or 8th century AD. There they used the drug as medicine until
approximately the 17th century when they realized that it could be smoked.
Following that, the Portuguese and British supplied China with a majority of its opium.
This made Britain the world's largest supplier of opium. What took place was that the
opium was sold to India to then be smuggled into China; this gave Britain the ability to
say that they were operating legally. When China realized what the British were doing
they began to destroy the opium before it reached China which was the beginning of two
wars. In the treaties that were written Britain ended up with Hong Kong, extra trading
rights and sixty million pounds in compensation for the destroyed opium.
The actual drug known as heroin was created in 1874. It was originally thought of as safe
and used as a non-addictive substitute for the drug morphine. Shortly after, it was
realized that heroin was just as addictive as morphine and was not an alternative for
morphine dependence. Heroin and other opiates that were not safe to use medically and
served no purpose otherwise were made illegal in 1920 under the Dangerous Drug Act.
 Heroin Addiction Ruins Families Heroin Addiction Destroys Carrers

Every drug has different signs and symptoms of use, heroin is no different. Heroin users
who inject the drug typically will cover up the injection area by wearing a long sleeved
shirt or long pants. After repeated use of heroin the individual will begin to develop track
marks in the areas that they inject most. These will appear as puncture marks that may
be bruised or even infected if left without medical care. All heroin users will have pin-point
pupils while on the drug. This is a reaction caused by opiates and is not uncommon.
Heroin creates a feeling of well-being in the user that they are not able to obtain from
their everyday lives. When they use they forget about their problems for the short while
they are high and feel relaxed and good. These feelings of pleasure soon turn to pain
when heroin withdrawal sets in. Heroin withdrawal is an exceptionally painful process.
This takes place when individuals who are dependent on heroin discontinue using. The
withdrawal symptoms range from depression, nausea, convulsions, up to abnormal
heartbeat and heart attacks.
There are different levels of drug addiction. Heroin is both addictive mentally and
physically. The user not only craves the drug to feel good, but needs it to avoid
withdrawal. This becomes a double edged sword for those individuals who try to end their
dependence on the drug. Many find that as the withdrawal symptoms become worse they
are unable to stay away from the drug, knowing that using will end their suffering and
pain. Many turn to methadone to supplement heroin so that they do not have to
experience heroin's withdrawal symptoms. In the end they find that they are either
dependent on methadone for the rest of their lives or the withdrawal from methadone is
even more painful and unbearable than when they tried to withdrawal from heroin.
Individuals who suffer from heroin dependence will find that attending a drug rehab is an
excellent way to end their problem. Once entered into a treatment facility they will be
detoxed from the drug. During this time they will be monitored carefully to make sure
that their pain and suffering from heroin withdrawal is not to overwhelming. Detox
provides the individual with a safe environment to rid themselves from the drug and
begin to feel better. This is not the end of recovery though. The individual still needs help
in remaining drug free. Attendance at a recovery facility is necessary to provide the
former heroin addict with the skills necessary to prevent them from returning to their old
ways.
Cocaine
Cocaine is produced from the Coca leaf.
These leaves are grown mainly in South
America. Cocaine is addictive and can
cause numerous physical and mental
complications to the user.
Once extracted from the leaf cocaine exists
as a white powder or as crack cocaine. In
crack cocaine the cocaine is heated with
ammonia, water and sodium bicarbonate.
This is known as free basing. This can be
very dangerous and the mixture is unstable
and may explode. Crack cocaine is
produced for smoking.

Effects:
Cocaine can be taken in many ways. Snorting cocaine may lead to a loss of sense of
smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the
nasal passage. When ingesting cocaine it can causes reduced blow flow and thus
producing severe bowel gangrene. Injecting cocaine may also produce an allergic
reaction. This can be either due to the drug or to some additive it has been cut with. This
can result in death but only in severe cases. Cocaine can also cause a loss of appetite in
heavy users can experience significant weight loss and malnourishment.
The user can feel invincible and confident due to a powerful buzz. Animated and intense
talking, feelings of well being and strength are common, as well as a preoccupation with
the effect of the drug. The intense high lasts 10 - 15 minutes. The remaining effects
disappearing within an hour. As a result the user may need repeated doses to maintain
the high. The user may feel a constant need for more to obtain the same effect.

Legal Status:
Cocaine may be prescribed in certain circumstances, otherwise they are illegal to
possess, supply or produce, (unless authorized to do so). Similarly it is illegal to allow
premises to be used for their supply or production.

Symptoms:
With an excess amount of cocaine within the human system the symptoms can include:
• Chest pain and heart attacks.
• Nausea.
• Blurred vision.
• Fever.
• Muscle spasms.
• Convulsions.
• Coma.
• Anxiousness.
• Aggressiveness.
Why drugs are being used by people?
There are many reasons why people use drugs. Some people use drugs because they like
the rush it gives them or because they are thrill-seekers. Others may try a drug out of
curiosity or because their friends do it. However, many people use drugs in order to cope
with unpleasant emotions and the difficulties of life. In fact, the National Alliance on
Mental Illness estimates that around 50% of drug abusers also suffer from a mental illness
such as depression, anxiety, bipolar disorder, or schizophrenia.
People who are suffering emotionally use drugs—not in order to get high—but to feel
normal. Drug use can be a seemingly attractive and easy escape from all kinds of
problems. Speed might be used to fight feelings of inferiority, sleeping pills to deal with
panic attacks, or painkillers to numb depression. However while drug use might make a
person feel better in the short-term, this attempt to self-medicate ultimately backfires.
Instead of treating the underlying problem, drug use simply masks the symptoms. Take
the drug away and the problem is still there, whether it be low self-esteem, stress, or an
unhappy family life. Furthermore, prolonged drug use eventually brings its own host of
problems, including major disruptions to normal, daily functioning. Unfortunately, the
psychological, physical, and social consequences of drug abuse and dependence are
often worse than the original problem the user was trying to cope with or avoid.

Warning Signs of Teen Drug Use:

• Negative changes in schoolwork, missing school, or declining grades.

• Increased secrecy about possessions or activities.
• Use of incense, room deodorant, or perfume to hide smoke or chemical odors.
• Subtle changes in conversations with friends (more secretive, using “coded”
language).
• New friends.
• Change in clothing choices — new fascination with clothes that highlight drug use.
• Increase in borrowing money.
• Evidence of drug paraphernalia, such as pipes and rolling papers.
• Evidence of inhaling products and accessories, such as hairspray, nail polish,
correction fluid, paper bags and rags, and common household products.
• Bottles of eye drops, which may be used to mask bloodshot eyes or dilated pupils.
• New use of mouthwash or breath mints to cover up the smell of alcohol.
• Missing prescription drugs — especially narcotics and mood stabilizers.

What are the signs and symptoms of drug addiction and abuse?

The more drug use begins to affect and control a person's life, the more likely it is that he
or she has a drug problem. Unfortunately, substance abusers are often the last ones to
recognize their own symptoms of dependence and addiction. If you suspect that a friend
or loved one is abusing drugs, it's important to remember that drug abusers often try to
conceal their symptoms and downplay their problem. But there are a number of warning
signs you can look for:

• Inability to relax or have fun without doing drugs.

• Sudden changes in work or school attendance and quality of work or grades.
• Frequently borrowing money, selling possessions, or stealing items from
employer, home, or school.
 • Angry outbursts, mood swings, irritability, manic behavior, or overall attitude
change.
• Talking incoherently or making inappropriate remarks.
• Deterioration of physical appearance and grooming.
• Wearing sunglasses and/or long sleeve shirts frequently or at inappropriate times.
• No longer spending time with friends who don't use drugs and/or associating with
known users.
• Engaging in secretive or suspicious behaviors, such as making frequent trips to
the restroom, basement, or other isolated areas where drug use would be
undisturbed.
• Talking about drugs all the time and pressuring others to use.
• Expressing feelings of exhaustion, depression, and hopelessness.
• Using drugs first thing in the morning.

Drug Addiction Treatment:

There are many addictive drugs, and treatments for specific drugs can differ. Treatment
also varies depending on the characteristics of the patient.
Problems associated with an individual's drug addiction can vary significantly. People who
are addicted to drugs come from all walks of life. Many suffer from mental health,
occupational, health, or social problems that make their addictive disorders much more
difficult to treat. Even if there are few associated problems, the severity of addiction itself
ranges widely among people.
A variety of scientifically based approaches to drug addiction treatment exists. Drug
addiction treatment can include behavioral therapy (such as counseling, cognitive
therapy, or psychotherapy), medications, or their combination. Behavioral therapies offer
people strategies for coping with their drug cravings, teach them ways to avoid drugs and
prevent relapse, and help them deal with relapse if it occurs. When a person's drug-
related behavior places him or her at higher risk for AIDS or other infectious diseases,
behavioral therapies can help to reduce the risk of disease transmission. Case
management and referral to other medical, psychological, and social services are crucial
components of treatment for many patients. The best programs provide a combination of
therapies and other services to meet the needs of the individual patient, which are
shaped by such issues as age, race, culture, sexual orientation, gender, pregnancy,
parenting, housing, and employment, as well as physical and sexual abuse.

Treatment medications, such as methadone, LAAM, and naltrexone, are available for
individuals addicted to opiates. Nicotine preparations (patches, gum, nasal spray) and
bupropion are available for individuals addicted to nicotine.

Components of Comprehensive Drug Abuse Treatment

The best treatment programs provide a combination of therapies and other services to
meet the needs of the individual patient.

Medications, such as antidepressants, mood stabilizers, or neuroleptics, may be critical

for treatment success when patients have co-occurring mental disorders, such as
depression, anxiety disorder, bipolar disorder, or psychosis.
Treatment can occur in a variety of settings, in many different forms, and for different
lengths of time. Because drug addiction is typically a chronic disorder characterized by
occasional relapses, a short-term, one-time treatment often is not sufficient. For many,
treatment is a long-term process that involves multiple interventions and attempts at
abstinence.
Why can't drug addicts quit on their own?

Nearly all addicted individuals believe in the beginning that they can stop using drugs on
their own, and most try to stop without treatment. However, most of these attempts
result in failure to achieve long-term abstinence. Research has shown that long-term drug
use results in significant changes in brain function that persist long after the individual
stops using drugs. These drug-induced changes in brain function may have many
behavioral consequences, including the compulsion to use drugs despite adverse
consequences the defining characteristic of addiction.

Understanding that addiction has such an important biological component may help
explain an individual's difficulty in achieving and maintaining abstinence without
treatment. Psychological stress from work or family problems, social cues (such as
meeting individuals from one's drug-using past), or the environment (such as
encountering streets, objects, or even smells associated with drug use) can interact with
biological factors to hinder attainment of sustained abstinence and make relapse more
likely. Research studies indicate that even the most severely addicted individuals can
participate actively in treatment and that active participation is essential to good
outcomes.

How effective is drug addiction treatment?

In addition to stopping drug use, the goal of treatment is to return the individual to
productive functioning in the family, workplace, and community. Measures of
effectiveness typically include levels of criminal behavior, family functioning,
employability, and medical condition. Overall, treatment of addiction is as successful as
treatment of other chronic diseases, such as diabetes, hypertension, and asthma.

According to several studies, drug treatment reduces drug use by 40 to 60 percent and
significantly decreases criminal activity during and after treatment. For example, a study
of therapeutic community treatment for drug offenders demonstrated that arrests for
violent and nonviolent criminal acts were reduced by 40 percent or more. Methadone
treatment has been shown to decrease criminal behavior by as much as 50 percent.
Research shows that drug addiction treatment reduces the risk of HIV infection and that
interventions to prevent HIV are much less costly than treating HIV-related illnesses.
Treatment can improve the prospects for employment, with gains of up to 40 percent
after treatment.
Although these effectiveness rates hold in general, individual treatment outcomes
depend on the extent and nature of the patient's presenting problems, the
appropriateness of the treatment components and related services used to address those
problems, and the degree of active engagement of the patient in the treatment process.

How long does drug addiction treatment usually last?

Individuals progress through drug addiction treatment at various speeds, so there is no

predetermined length of treatment. However, research has shown unequivocally that
good outcomes are contingent on adequate lengths of treatment. Generally, for
residential or outpatient treatment, participation for less than 90 days is of limited or no
effectiveness, and treatments lasting significantly longer often are indicated. For
methadone maintenance, 12 months of treatment is the minimum, and some opiate-
addicted individuals will continue to benefit from methadone maintenance treatment over
a period of years.
Many people who enter treatment drop out before receiving all the benefits that
treatment can provide. Successful outcomes may require more than one treatment
experience. Many addicted individuals have multiple episodes of treatment, often with a
cumulative impact.
What helps people stay in treatment?

Since successful outcomes often depend upon retaining the person long enough to gain
the full benefits of treatment, strategies for keeping an individual in the program are
critical. Whether a patient stays in treatment depends on factors associated with both the
individual and the program. Individual factors related to engagement and retention
include motivation to change drug-using behavior, degree of support from family and
friends, and whether there is pressure to stay in treatment from the criminal justice
system, child protection services, employers, or the family. Within the program,
successful counselors are able to establish a positive, therapeutic relationship with the
patient. The counselor should ensure that a treatment plan is established and followed so
that the individual knows what to expect during treatment. Medical, psychiatric, and
social services should be available.

Since some individual problems (such as serious mental illness, severe cocaine or crack
use, and criminal involvement) increase the likelihood of a patient dropping out, intensive
treatment with a range of components may be required to retain patients who have these
problems. The provider then should ensure a transition to continuing care or "aftercare"
following the patient's completion of formal treatment.

Principles of Effective Treatment

1. No single treatment is appropriate for all individuals. Matching treatment

settings, interventions, and services to each individual's particular problems and needs
is critical to his or her ultimate success in returning to productive functioning in the
family, workplace, and society.
2. Treatment needs to be readily available. Because individuals who are addicted to
drugs may be uncertain about entering treatment, taking advantage of opportunities
when they are ready for treatment is crucial. Potential treatment applicants can be lost
if treatment is not immediately available or is not readily accessible.
3. Effective treatment attends to multiple needs of the individual, not just his or
her drug use. To be effective, treatment must address the individual's drug use and
any associated medical, psychological, social, vocational, and legal problems.
4. An individual's treatment and services plan must be assessed continually and
modified as necessary to ensure that the plan meets the person's changing
needs. A patient may require varying combinations of services and treatment
components during the course of treatment and recovery. In addition to counseling or
psychotherapy, a patient at times may require medication, other medical services,
family therapy, parenting instruction, vocational rehabilitation, and social and legal
services. It is critical that the treatment approach be appropriate to the individual's age,
gender, ethnicity, and culture.
5. Remaining in treatment for an adequate period of time is critical for
treatment effectiveness. The appropriate duration for an individual depends on his
or her problems and needs (see pages 11-49). Research indicates that for most
patients, the threshold of significant improvement is reached at about 3 months in
treatment. After this threshold is reached, additional treatment can produce further
progress toward recovery. Because people often leave treatment prematurely,
programs should include strategies to engage and keep patients in treatment.
6. Counseling (individual and/or group) and other behavioral therapies are
critical components of effective treatment for addiction. In therapy, patients
address issues of motivation, build skills to resist drug use, replace drug-using activities
with constructive and rewarding nondrug-using activities, and improve problem-solving
abilities. Behavioral therapy also facilitates interpersonal relationships and the
individual's ability to function in the family and community.
7. Medications are an important element of treatment for many patients,
especially when combined with counseling and other behavioral therapies.
Methadone and levo-alpha-acetylmethadol (LAAM) are very effective in helping
individuals addicted to heroin or other opiates stabilize their lives and reduce their illicit
drug use. Naltrexone is also an effective medication for some opiate addicts and some
patients with co-occurring alcohol dependence. For persons addicted to nicotine, a
nicotine replacement product (such as patches or gum) or an oral medication (such as
bupropion) can be an effective component of treatment. For patients with mental
disorders, both behavioral treatments and medications can be critically important.
8. Addicted or drug-abusing individuals with coexisting mental disorders should
have both disorders treated in an integrated way. Because addictive disorders
and mental disorders often occur in the same individual, patients presenting for either
condition should be assessed and treated for the co-occurrence of the other type of
disorder.
9. Medical detoxification is only the first stage of addiction treatment and by
itself does little to change long-term drug use. Medical detoxification safely
manages the acute physical symptoms of withdrawal associated with stopping drug
use. While detoxification alone is rarely sufficient to help addicts achieve long-term
abstinence, for some individuals it is a strongly indicated precursor to effective drug
addiction treatment
10. Treatment does not need to be voluntary to be effective. Strong motivation can
facilitate the treatment process. Sanctions or enticements in the family, employment
setting, or criminal justice system can increase significantly both treatment entry and
retention rates and the success of drug treatment interventions.
11. Possible drug use during treatment must be monitored continuously. Lapses
to drug use can occur during treatment. The objective monitoring of a patient's drug
and alcohol use during treatment, such as through urinalysis or other tests, can help
the patient withstand urges to use drugs. Such monitoring also can provide early
evidence of drug use so that the individual's treatment plan can be adjusted. Feedback
to patients who test positive for illicit drug use is an important element of monitoring.
12. Treatment programs should provide assessment for HIV/AIDS, hepatitis B
and C, tuberculosis and other infectious diseases, and counseling to help
patients modify or change behaviors that place themselves or others at risk
of infection. Counseling can help patients avoid high-risk behavior. Counseling also
can help people who are already infected manage their illness?
13. Recovery from drug addiction can be a long-term process and frequently
requires multiple episodes of treatment. As with other chronic illnesses, relapses
to drug use can occur during or after successful treatment episodes. Addicted
individuals may require prolonged treatment and multiple episodes of treatment to
achieve long-term abstinence and fully restored functioning. Participation in self-help
support programs during and following treatment often is helpful in maintaining
abstinence.