Substance abuse treatment

McLellan AT Psychiatric severity as a predictor of outcome from substance abuse treatments, in Psychopathology and Addictive Disorders. Edited by Meyer RE. New York, Guilford, 1986, pp 97-139... 

McNicholas L, Howell EF Buprenorphine Clinical Practice Guidelines, Field Review Draft November 17, 2000. Rockville, MD, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, Office of Pharmacologic and Alternative Therapies, 2000... 

A dramatically different pattern is found in surveys of drug abuse treatment facilities. Substance abuse treatment centers have reported that more than 20% of patients use benzodiazepines weekly or more frequently, with 30%— 90% of opioid abusers reporting illicit use (Iguchi et al. 1993 Stitzer et al 1981). Methadone clinics reported that high proportions ofurine samples are positive for benzodiazepines (Darke et al. 2003 Dinwiddle et al. 1996 Ross and Darke 2000 Seivewright 2001 Strain et al. 1991 Williams et al. 1996). The reasons for the high rates of benzodiazepine use in opioid addicts include self-medication of insomnia, anxiety, and withdrawal symptoms, as well as attempts to boost the euphoric effects of opioids. 

Chermack ST, Blow FC Violence among individuals in substance abuse treatment the role of alcohol and cocaine consumption. Drug Alcohol Depend 66 29—37, 2002... 

Outpatient group members were very similar to the inpatient PCP abusers in most sociodemographic and drug-use characteristics. Their mean age was 29 years, educational level 12.6 years, and number of prior arrests 1.5. The majority of outpatients were black (83 percent), unmarried (67 percent), and unemployed (67 percent). Their mean duration of PCP use was almost 8 years, with, usually, no prior or recent substance abuse treatment. Thirty-seven percent used PCP at least daily, always by smoking. Like the inpatient PCP abusers, outpatients frequently (87 percent) reported abuse of other drugs alcohol (46 percent), marijuana (46 percent), and cocaine (37 percent). Several outpatients for whom cocaine was the preferred drug of abuse used PCP as a "cheaper high" when cocaine was not affordable. 

The treatment goals for withdrawal from ethanol, cocaine/ amphetamines, and opioids include (1) a determination if pharmacologic treatment of withdrawal symptoms is necessary, (2) management of medical manifestations of withdrawal such as hypertension, seizures, arthralgias, and nausea, and (3) referral to the appropriate program for substance abuse treatment. 

A number of medications have been studied to alleviate symptoms of stimulant withdrawal and the intense craving that may accompany it, but inconsistent results across controlled trials preclude any recommendations for their routine use. Patients with stimulant use disorders should be referred to substance abuse treatment because of the high risk for continued use either during or immediately following stimulant withdrawal. 

Galanter M, Kleber HD. Textbook of Substance Abuse Treatment. 3rd ed. Washington, DC American Psychiatric Publishing, 2004. 

Kozlowski, L. T., Henningfield, J. E., Keenan, R. M., Lei, H., et al., Patterns of alcohol, cigarette, and caffeine and other drug use in two drug abusing populations. Special Issue Towards a broader view of recovery Integrating nicotine addiction and chemical dependency treatments. Journal of Substance Abuse Treatment, 1993 Mar-Apr Vol 10(2), 171-179, 1993. 

Chiauzzi, E. J., Liljegren, S. (1993). Taboo topics in addiction treatment An empirical review of clinical folklore. Journal of Substance Abuse Treatment, 10, 303-316. 

Meyers, K., McLellan, A. T., Jaeger, J. L., Petdnati, H. M. (1995). The development of the Comprehensive Addiction Severity Index for Adolescents (CASI-A) An interview for assessing multiple problems of adolescents. Journal of Substance Abuse Treatment, 12, 181-193. 

Other important documents in HSTAT include the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports the HIV/AIDS Treatment Information Service (ATIS) resource documents the Substance Abuse and Mental Health Services Administration s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS) the Public Health Service (PHS) Preventive Services Task Force s Guide to Clinical Preventive Services the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 

There are a wide variety of medications that have been used to treat substance use disorders. Although medication choices vary to some extent depending on the motivation of the patient and the substance being abused, there are a handful of theoretical bases that are common to all substance abuse treatment. We briefly review some of these theories. 

Dowe, G., M. F. Smilkle, C. Thesiger, and E. M. Williams. Bloodbome sexually transmitted infections in patients presenting for substance abuse treatment in Jamaica. Sex Transm Dis 2001 28(5) 266-269. 

Porowski, A., Burgdorf, K. and Herrell, J. (2004) Effectiveness and sustainability of residential substance abuse treatment programs for pregnant and parenting women. Evaluation and Program... 

Williams, R.J. and Chang, S.Y. (2000) A comprehensive and comparative review of adolescent substance abuse treatment outcomes. Clinical Psychology Science and Practice 7, 2, 138-166. 

Wise, B., Cuffe, S., and Fischer T. (2001) Dual diagnosis and successful participation of adolescents in substance abuse treatment. Journal of Substance Abuse Treatment 219 161-165. 

Banbery J, Wolff K Raistrick D (2000). Dihydrocodeine a useful tool in the detoxification of methadone-maintained patients. Journal of Substance Abuse Treatment, 19, 301-5... 

British National Formulary (2008). Vol 55 Broekaert E Vanderplasschen W (2003). Towards the integration of treatment systems for substance abusers Report on the Second International Symposium on Substance Abuse Treatment and Special Target Groups. Journal of Psychoactive Drugs, 35, 237-45... 

Covi L, Hess JM, Kreiter NA Haertzen CA (1995). Effects of combined fluoxetine and counselling in the outpatient treatment of cocaine abusers. American Journal of Drug Alcohol Abuse, 21, 327-44 Craig RJ, Olson R Shalton G (1990). Improvement in psychological functioning among drug abusers inpatient treatment compared to outpatient methadone maintenance. Journal of Substance Abuse Treatment, 1, 11-19... 

Flynn PM, Joe GW, Broome KM, Simpson DD Brown BS (2003). Recovery from opioid addiction in DATOS. Journal of Substance Abuse Treatment, 25, 177-86... 

Kaminer Y (2002). Adolescent substance abuse treatment evidence-based practice in outpatient services. Current Psychiatry Reports, 4, 397-401... 

Pollack MH, Penava SA, Bolton E, Worthington JJ, Allen GL, Farach FJ Otto MW (2002). A novel cognitive-hehavioral approach for treatment-resistant drug dependence. Journal of Substance Abuse Treatment, 23, 335-42... 

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