understanding drug abuse and addiction: what science says developed by the national institute on...
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Understanding Drug Abuse and Understanding Drug Abuse and
Addiction:Addiction: What Science SaysWhat Science Says
Developed by theDeveloped by theNational Institute on Drug Abuse (NIDA)National Institute on Drug Abuse (NIDA)
National Institutes of HealthNational Institutes of HealthBethesda, MarylandBethesda, Maryland
www.drugabuse.gov
DRUG ADDICTION IS A COMPLEX ILLNESSDRUG ADDICTION IS A COMPLEX ILLNESS
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Positron Emission TomographyPositron Emission Tomography
(PET)(PET)
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controlcontrol on cocaineon cocaine
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ineffective parentingineffective parenting chaotic home environmentchaotic home environment lack of mutual attachments/nurturinglack of mutual attachments/nurturing inappropriate behavior in the classroominappropriate behavior in the classroom failure in school performancefailure in school performance poor social coping skillspoor social coping skills affiliations with deviant peersaffiliations with deviant peers perceptions of approval of drug-using perceptions of approval of drug-using
behaviors in the school, peer, and behaviors in the school, peer, and community environmentscommunity environments
Prevention Programs Should . . . .Prevention Programs Should . . . .Reduce Risk FactorsReduce Risk Factors
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Prevention Programs Prevention Programs Should . . . .Should . . . .
strong family bondsstrong family bonds parental monitoringparental monitoring parental involvementparental involvement success in school performancesuccess in school performance prosocial institutions (e.g. such as prosocial institutions (e.g. such as
family, school, and religious family, school, and religious organizations)organizations)
conventional norms about drug useconventional norms about drug use
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Enhance Protective FactorsEnhance Protective Factors
. . . and be Culturally . . . and be Culturally SensitiveSensitive
Prevention Programs Should . . . .Prevention Programs Should . . . .
. .. .Target all Forms of Drug UseTarget all Forms of Drug Use
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Resist drugsResist drugs
Strengthen personal Strengthen personal commitments against drug usecommitments against drug use
Increase social competencyIncrease social competency
Reinforce attitudes against Reinforce attitudes against drug usedrug use
Prevention Programs Should . . . .Prevention Programs Should . . . .
Include Interactive Skills-Based Include Interactive Skills-Based TrainingTraining
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Provide greater impact than parent-Provide greater impact than parent-only or child-only programsonly or child-only programs
Include at each stage of Include at each stage of developmentdevelopment
Involve effective parenting skillsInvolve effective parenting skills
Prevention Programs Should. . . .Prevention Programs Should. . . .
Be Family-FocusedBe Family-Focused
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Prevention Programs Should . . . .Prevention Programs Should . . . .
Involve Communities and SchoolsInvolve Communities and Schools
Incorporate media campaigns and Incorporate media campaigns and policy changespolicy changes
Strengthen norms against drug Strengthen norms against drug useuse
Address specific nature of local Address specific nature of local drug problemdrug problem
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Components of Comprehensive Components of Comprehensive Drug Addiction TreatmentDrug Addiction Treatment
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Matching Patients to Matching Patients to Individual NeedsIndividual Needs
No single treatment is appropriate No single treatment is appropriate for all individualsfor all individuals
Effective treatment attends to Effective treatment attends to multiple needs of the individual, not multiple needs of the individual, not just his/her drug usejust his/her drug use
Treatment must address medical, Treatment must address medical, psychological, social, vocational, psychological, social, vocational, and legal problemsand legal problems
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Duration of TreatmentDuration of Treatment
Depends on patient problems/needsDepends on patient problems/needs
Less than 90 days is of limited/no Less than 90 days is of limited/no effectiveness for residential/outpatient effectiveness for residential/outpatient settingsetting
A minimum of 12 months is required for A minimum of 12 months is required for methadone maintenancemethadone maintenance
Longer treatment is often indicatedLonger treatment is often indicated
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Medical DetoxificationMedical Detoxification
Detoxification safely manages the physical Detoxification safely manages the physical symptoms of withdrawalsymptoms of withdrawal
Only first stage of addiction treatmentOnly first stage of addiction treatment
Alone, does little to change long-term drug useAlone, does little to change long-term drug use
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Counseling and Other Behavioral Counseling and Other Behavioral TherapiesTherapies
DrugResistanceSkills
Replace Drug Using
Activities
Motivation
Problem Solving Skills
Interpersonal Relationships
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Medications for Drug Medications for Drug AddictionAddiction
BuprenorphineBuprenorphine
MethadoneMethadone
LAAMLAAM
NaltrexoneNaltrexone
Nicotine ReplacementNicotine Replacement patchespatches gumgum buproprionbuproprion
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Motivation to Enter/Motivation to Enter/Sustain TreatmentSustain Treatment
Effective treatment need not be voluntaryEffective treatment need not be voluntary
Sanctions/enticements (family, employer, Sanctions/enticements (family, employer, criminal justice system) can increase criminal justice system) can increase treatment entry/retentiontreatment entry/retention
Treatment outcomes are similar for those Treatment outcomes are similar for those who enter treatment under legal pressure who enter treatment under legal pressure vs voluntaryvs voluntary
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HIV/AIDS, Hepatitis and HIV/AIDS, Hepatitis and Other Infectious DiseasesOther Infectious Diseases
Drug treatment is disease Drug treatment is disease preventionprevention
Drug treatment reduces likelihood Drug treatment reduces likelihood of HIV infection by 6 fold in of HIV infection by 6 fold in injecting drug usersinjecting drug users
Drug treatment presents Drug treatment presents opportunities for screening, opportunities for screening, counseling, and referral counseling, and referral
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Effectiveness of Effectiveness of TreatmentTreatment
Goal of treatment is to return to Goal of treatment is to return to productive functioningproductive functioning
Treatment reduced drug use by 40-60% Treatment reduced drug use by 40-60% Treatment reduces crime by 40-60% Treatment reduces crime by 40-60% Treatment increases employment Treatment increases employment
prospects by 40% prospects by 40% Drug treatment is as successful as Drug treatment is as successful as
treatment of diabetes, asthma, and treatment of diabetes, asthma, and hypertensionhypertension
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Self-Help and DrugSelf-Help and DrugAddiction TreatmentAddiction Treatment
Complements and extends treatment effortsComplements and extends treatment efforts
Most commonly used models include 12-Step Most commonly used models include 12-Step (AA, NA) and Smart Recovery(AA, NA) and Smart Recovery
Most treatment programs encourage self-Most treatment programs encourage self-help participation during/after treatmenthelp participation during/after treatment
www.drugabuse.gov
Cost-Effectiveness of Drug Cost-Effectiveness of Drug TreatmentTreatment
Treatment is less expensive than not treating Treatment is less expensive than not treating or incarceration (1 yr methadone maintenance = or incarceration (1 yr methadone maintenance = $4,700 vs. $18,400 for imprisonment)$4,700 vs. $18,400 for imprisonment)
Every $1 invested in treatment yields up to $7 Every $1 invested in treatment yields up to $7 in reduced crime-related costsin reduced crime-related costs
Savings can exceed costs by 12:1 when health Savings can exceed costs by 12:1 when health care costs are includedcare costs are included
Reduced interpersonal conflictsReduced interpersonal conflicts Improved workplace productivityImproved workplace productivity Fewer drug-related accidentsFewer drug-related accidents
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For More InformationFor More Information
NIDA Public Information Office: NIDA Public Information Office: 301-443-1124301-443-1124
Or Or www.nida.nih.govwww.drugabuse.gov
National Clearinghouse on Alcohol and National Clearinghouse on Alcohol and Drug Information (NCADI): Drug Information (NCADI):
1-800-729-66861-800-729-6686
www.drugabuse.gov