Treatment Settings

Treatment for heroin dependence is offered in publicly funded clinics that accept patients with limited resources, including those who receive public assistance. It is also treated in private programs that take patients with higher incomes and/or medical insurance. Treatment for heroin abuse is often defined by the setting in which it is delivered, not by the actual content of treatment, which may or may not differ across treatment settings. For example, outpatient and inpatient clinics may offer remarkably similar services for drug abusers. One exception is the Therapeutic Community, where the treatment philosophy and approach are uniquely associated with long-term recuperation in a residential setting. Treatments are also labeled with regard to the relative role of psychological versus pharmacological interventions used. With Methadone Maintenance, for example, counseling and psychotherapy are viewed as secondary, although complementary, to the daily oral administration of methadone—a drug that replaces heroin within the dependence mode. At the opposite end of the spectrum are residential therapeutic communities and Twelve-Step self-help programs, in which the entire intervention consists of social and behavioral modeling, with no use of medications. Drug-abuse treatment may also be distinguished by whether it is offered in a hospital versus a community clinic outpatient setting. Outpatient clinics usually emphasize psychological techniques, by providing counseling and psychotherapy services. Hospital chemical dependency units usually offer medical detoxification that involves prescribed medications along with some combination of psychological approaches. These detoxification services are important for helping heroin- dependent people make the transition to a drug-free state. However, it is also important that they continue in treatment at the same or another state program after the detoxification has been completed. Those who follow this recommendation are more likely to remain abstinent and to continue working on the lifestyle changes needed for long-term successful outcomes. In this chapter, we will describe the content of psychological interventions for heroin abuse independent of the settings in which they are typically administered.

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