The National Institute on Drug Abuse (NIDA) has published the first-ever science-based guide to drug addiction treatment. In its Principles of Drug Addiction Treatment: A Research-Based Guide, the institute outlines some of the essential components of drug addiction and its treatment based on 30 years of scientific research.”There is no ‘one size fits all’ drug addiction treatment program,” says Alan I. Leshner, PhD, NIDA’s director. “Because addiction has so many dimensions and disrupts so many aspects of an individual’s life, the best programs provide a combination of therapies and other services, such as referral to other medical, psychological, and social services. The combination of addiction treatment components and services to be employed must be tailored to meet the needs of the individual, including where he or she is in the recovery process.”
He also notes that addiction treatment is tremendously cost effective — it is estimated that for every $1 spent on addiction treatment programs, there is a $4 to $7 reduction in drug-related crime, criminal justice costs, and theft alone. When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and to society also come from significant drops in interpersonal conflicts, improvements in workplace productivity, and reductions in drug-related accidents.
The publication coincided with an article by Dr Leshner in the October 13, 1999, issue of The Journal of the American Medical Association. In the JAMA article, he notes, “…advances in science have greatly increased, and in fact revolutionized, our fundamental understanding of the nature of drug abuse and drug addiction, and, most importantly, what to do about it.”
He continues, “Although the onset of addiction begins with the voluntary act of taking drugs, the continued repetition of ‘voluntary’ drug taking begins to change into ‘involuntary’ drug taking, ultimately to the point where the behavior is driven by compulsive craving for the drug. This compulsion results from a combination of factors, including in large part dramatic changes in brain function produced by prolonged drug use. This is why drug addiction is considered a brain disease — one with imbedded behavioral and social context aspects. Once addicted, it is almost impossible for most people to stop the spiraling cycle of drug addiction on their own without a drug treatment program.”
While the JAMA article was written primarily to inform physicians about drug addiction and the effectiveness of treatment, the Principles of Drug Addiction Treatment booklet is intended for health care professionals and the general public.
Among the principles and concepts spelled out in this guide, Dr Leshner emphasizes two points: Treatment of addiction is as successful as treatment of other chronic diseases such as diabetes, hypertension, and asthma; and for those with severe drug addiction problems, participation in addiction treatment for less than 90 days is of limited or no effectiveness.
“Three decades of research and clinical practice have revolutionized our understanding of drug abuse. It is hoped that these addiction treatment principles will serve as a foundation for replacing ideologies about drug addiction with science-based treatment,” Dr Leshner says.
