General Categories of Drug Treatment Programs

Written by National Institute of Drug Abuse

A description of the types of drug treatment approaches and drug treatment programs effective in reducing and ending drug addiction.

Research studies on drug addiction treatment have typically classified drug treatment programs into several general types or modalities, which are described in the following text. Drug treatment approaches and individual programs continue to evolve, and many programs in existence today do not fit neatly into traditional drug addiction treatment classifications. Examples of specific research-based treatment components are described in the Approaches to Treatment Section.

Agonist Maintenance Treatment

Agonist maintenance treatment for opiate addicts usually is conducted in outpatient settings, often called methadone treatment programs. These programs use a long-acting synthetic opiate medication, usually methadone or LAAM, administered orally for a sustained period at a dosage sufficient to prevent opiate withdrawal, block the effects of illicit opiate use, and decrease opiate craving. Patients stabilized on adequate, sustained dosages of methadone or LAAM can function normally. They can hold jobs, avoid the crime and violence of the street culture, and reduce their exposure to HIV by stopping or decreasing injection drug use and drug-related high-risk sexual behavior.

Patients stabilized on opiate agonists can engage more readily in counseling and other behavioral interventions essential to recovery and rehabilitation. The best, most effective opiate agonist maintenance programs include individual and/or group counseling, as well as provision of, or referral to, other needed medical, psychological, and social services.

Further Reading:

Ball, J.C., and Ross, A. The Effectiveness of Methadone Treatment. New York: Springer-Verlag, 1991.

Cooper, J.R. Ineffective use of psychoactive drugs; Methadone treatment is no exception. JAMA Jan 8; 267(2): 281-282, 1992.

Dole, V.P.; Nyswander, M.; and Kreek, M.J. Narcotic Blockade. Archives of Internal Medicine 118: 304-309, 1996.

Lowinson, J.H.; Payte, J.T.; Joseph, H.; Marion, I.J.; and Dole, V.P. Methadone Maintenance. In: Lowinson, J.H.; Ruiz, P.; Millman, R.B.; and Langrod, J.G., eds. Substance Abuse: A Comprehensive Textbook. Baltimore, MD, Lippincott, Williams & Wilkins, 1996, pp. 405-414.

McLellan, A.T.; Arndt, I.O.; Metzger, D.S.; Woody, G.E.; and O'Brien, C.P. The effects of psychosocial services in substance abuse treatment. JAMA Apr 21; 269(15): 1953-1959, 1993.

Novick, D.M.; Joseph, J.; Croxson, T.S., et al. Absence of antibody to human immunodeficiency virus in long-term, socially rehabilitated methadone maintenance patients. Archives of Internal Medicine Jan; 150(1): 97-99, 1990.

Simpson, D.D.; Joe, G.W.; and Bracy, S.A. Six-year follow-up of opioid addicts after admission to treatment. Archives of General Psychiatry Nov; 39(11): 1318-1323, 1982.

Simpson, D.D. Treatment for drug abuse; Follow-up outcomes and length of time spent. Archives of General Psychiatry 38(8): 875-880, 1981.

Narcotic Antagonist Treatment Using

Narcotic antagonist treatment using Naltrexone for opiate addicts usually is conducted in outpatient settings although initiation of the medication often begins after medical detoxification in a residential setting. Naltrexone is a long-acting synthetic opiate antagonist with few side effects that is taken orally either daily or three times a week for a sustained period of time. Individuals must be medically detoxified and opiate-free for several days before naltrexone can be taken to prevent precipitating an opiate abstinence syndrome. When used this way, all the effects of self-administered opiates, including euphoria, are completely blocked. The theory behind this treatment is that the repeated lack of the desired opiate effects, as well as the perceived futility of using the opiate, will gradually over time result in breaking the habit of opiate addiction. Naltrexone itself has no subjective effects or potential for abuse and is not addicting. Patient noncompliance is a common problem. Therefore, a favorable treatment outcome requires that there also be a positive therapeutic relationship, effective drug addiction counseling or therapy, and careful monitoring of medication compliance.

Patients stabilized on naltrexone can hold jobs, avoid crime and violence, and reduce their exposure to HIV.

Many experienced clinicians have found naltrexone most useful for highly motivated, recently detoxified patients who desire total abstinence because of external circumstances, including impaired professionals, parolees, probationers, and prisoners in work-release status. Patients stabilized on naltrexone can function normally. They can hold jobs, avoid the crime and violence of the street culture, and reduce their exposure to HIV by stopping injection drug use and drug-related high-risk sexual behavior.