Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Treatment must be individualized, because no single treatment is appropriate for everyone or for each type of drug abuse.
Treatment is most effective when it is readily available.
Effective treatment often needs to address the multiple needs of the individual, not just his or her addiction.
As with all medical care, the treatment plan must be assessed continually and modified as a person's condition changes.
Remaining in a treatment program or participating in a treatment plan for an adequate amount of time is critical for the treatment to be effective. Research indicates that, for most patients, significant improvement generally begins about three months into treatment.
Behavior change is the most important element for effective treatment of addiction. Often this requires counseling or behavior modification treatment.
Medications can be an important part of treatment for some types of drug abuse, especially when combined with counseling and other behavioral therapies.
There is a significant amount of evidence that individuals with addictions and coexisting mental disorders (such as depression or anxiety disorders) should have both disorders treated in an integrated way.
Treatment does not have to be voluntary to be effective. For example, motivation by employers or family members can encourage people with addictions to seek out and continue treatment. This is thought to be the reason that physicians and nurses have some of the best recovery rates.
If appropriate, monitoring drug use during treatment, through urinalysis or other tests, can help a person withstand the urges to use drugs. Also, monitoring can provide early evidence of drug use so that the individual's treatment plan can be adjusted if he or she is still using drugs.
During treatment, individuals may need to be evaluated for infectious diseases such as HIV/AIDS, hepatitis B, hepatitis C, and tuberculosis. Treatment needs to include counseling to help the person change high-risk behavior or to deal with an existing disease.
Recovery from addiction can be a long-term process and can require more than one episode or type of treatment.
Medical detoxification (often simply referred to as detox) is needed for some addictions such as severe alcohol abuse. Detox is indicated only for some types of substance abuse. When needed, detox is only the first stage of addiction treatment and without further treatment does little to change long-term drug use. During medical detoxification, the acute physical symptoms of withdrawal associated with discontinuation of drug use are safely treated. This alone is rarely sufficient to help people with addictions in the long term, but for some individuals, it is a precursor to effective drug-addiction treatment.
Medications are an important element of therapy for many patients, especially when combined with counseling and other behavioral therapies. Methadone, buprenorphine (Suboxone), and levo-alpha-acetylmethadol (LAAM) can be prescribed for individuals addicted to heroin or other opiates. Naltrexone can be prescribed for some people addicted to alcohol and those with co-occurring opiate and alcohol dependence. Acamprosate (Campral) is an agent to help in maintaining abstinence in people with alcohol dependency. A nicotine replacement product (such as patches or gum) or an oral medication (such as bupropion) can be an effective component of therapy for people addicted to nicotine. For people with psychiatric disorders, both behavioral treatments and medications can be critically important.
At the current time, there is no indication for surgery for any type of substance or alcohol abuse or addiction.
Behavioral therapy or counseling may be used to accomplish the following:
Encourage and increase motivation for change from using an addicting drug
Help build skills to resist addiction-related activities
Replace addiction-related activities with more constructive and rewarding activities
Improve problem-solving abilities
Improve interpersonal relationships, including the individual's ability to function in the family and community
Family members, friends and coworkers can play critical roles in motivating individuals with drug problems to enter and stay in treatment. Family therapy is often important, especially for adolescents. Involvement of a family member in an individual's treatment program can strengthen and extend the benefits of the program.