The Integration Of Pharmacological And Psychosocial Treatments

No medication will prevent an addict who wants to use heroin from doing so. Naltrexone maintenance can be discontinued, and addicts who discontinue it are able within one to three days to use heroin without the naltrexone blockade. Similarly, methadone maintenance is ineffective in addicts who are unable or unwilling to meet the requirements of clinic attendance (which sometimes requires payment of fees) and staying out of prison. Addicts whose lives are in disarray require medications as part of a comprehensive treatment program that also addresses their other needs. In a street addict who chronically uses drugs, these may include needs for counseling, medical attention, vocational rehabilitation, and a host of other services. There is evidence that methadone treatment is more effective if a higher "dose" of psychosocial treatment is provided along with it.

Detoxification is a first step toward recovery because it makes the addict available to further psychosocial and medical treatments. There is evidence that mild physiological abnormalities due to withdrawal of opiates linger for as long as three months after detoxification. This "long-term abstinence syndrome'' is thought to contribute to the craving for opiates that occurs after detoxification. Naltrexone maintenance is most effective in addicts who have jobs and stable social supports—for example, in anesthesiologists who have become addicted to hospital medications. Because naltrexone itself is not reinforcing and many heroin addicts have a host of psychosocial problems, many clinics have reported that naltrexone maintenance alone was minimally effective in the treatment of long-term addicts.

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