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Short-term methods last less than 6 months and include residential therapy,
medication therapy, and drug-free outpatient therapy. Longer term treatment
may include, for example, methadone maintenance outpatient treatment for
opiate addicts and residential therapeutic community treatment.
In
maintenance treatment
for heroin addicts, people in treatment are given an oral dose of a synthetic
opiate, usually methadone hydrochloride or levo-alpha-acetyl methadol
(LAAM), administered at a dosage sufficient to block the effects of heroin
and yield a stable, noneuphoric state free from physiological craving
for opiates. In this stable state, the patient is able to disengage from
drug-seeking and related criminal behavior and, with appropriate counseling
and social services, become a productive member of his or her community.
Outpatient drug
treatment does not include medications and encompasses
a wide variety of programs for patients who visit a clinic at regular
intervals. Most of the programs involve individual or group counseling.
Patients entering these programs are abusers of drugs other than opiates
or are opiate abusers for whom maintenance therapy is not recommended,
such as those who have stable, well-integrated lives and only brief histories
of drug dependence.
Therapeutic communities (TCs)
are highly structured programs in which patients stay at a residence,
typically for 6 to 12 months. Patients in TCs include those with relatively
long histories of drug dependence, involvement in serious criminal activities,
and seriously impaired social functioning. The focus of the TC is on the
resocialization of the patient to a drug-free, crime-free lifestyle.
Short-term residential
programs, often referred to as chemical dependency units, are often
based on the "Minnesota Model" of treatment for alcoholism.
These programs involve a 3- to 6-week inpatient treatment phase followed
by extended outpatient therapy or participation in 12-step self-help groups,
such as Narcotics Anonymous or Cocaine Anonymous. Chemical dependency
programs for drug abuse arose in the private sector in the mid-1980s with
insured alcohol/cocaine abusers as their primary patients. Today, as private
provider benefits decline, more programs are extending their services
to publicly funded patients.
Methadone maintenance
programs are usually more successful at retaining clients with opiate
dependence than are therapeutic communities, which in turn are more successful
than outpatient programs that provide psychotherapy and counseling. Within
various methadone programs, those that provide higher doses of methadone
(usually a minimum of 60 mg.) have better retention rates. Also, those
that provide other services, such as counseling, therapy, and medical
care, along with methadone generally get better results than the programs
that provide minimal services.
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