General Categories of Drug Treatment Programs

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.

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.

Patients stabilized on adequate sustained dosages of methadone or LAAM can function normally.

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.

Further Reading:

Cornish, J.W.; Metzger, D.; Woody, G.E.; Wilson, D.; McLellan, A.T.; Vandergrift, B.; and O'Brien, C.P. Naltrexone pharmacotherapy for opioid dependent federal probationers. Journal of Substance Abuse Treatment 14(6): 529-534, 1997.

Greenstein, R.A.; Arndt, I.C.; McLellan, A.T.; and O'Brien, C.P. Naltrexone: a clinical perspective. Journal of Clinical Psychiatry 45 (9 Part 2): 25-28, 1984.

Resnick, R.B.; Schuyten-Resnick, E.; and Washton, A.M. Narcotic antagonists in the treatment of opioid dependence: review and commentary. Comprehensive Psychiatry 20(2): 116-125, 1979.

Resnick, R.B. and Washton, A.M. Clinical outcome with naltrexone: predictor variables and followup status in detoxified heroin addicts. Annals of the New York Academy of Sciences 311: 241-246, 1978.

Outpatient Drug-Free Treatment

Outpatient drug-free treatment in the types and intensity of services offered. Such treatment costs less than residential drug treatment or inpatient treatment and often is more suitable for individuals who are employed or who have extensive social supports. Low-intensity programs may offer little more than drug education and admonition. Other outpatient models, such as intensive day treatment, can be comparable to residential programs in services and effectiveness, depending on the individual patient's characteristics and needs. In many outpatient programs, group counseling is emphasized. Some outpatient programs are designed to treat patients who have medical or mental health problems in addition to their drug disorder.

Further Reading:

Higgins, S.T.; Budney, A.J.; Bickel, W.K.; Foerg, F.E.; Donham, R.; and Badger, G.J. Incentives to improve outcome in outpatient behavioral treatment of cocaine dependence. Archives of General Psychiatry 51, 568-576, 1994.

Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; Anderson, J.; and Etheridge, R.M. Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4): 291-298, 1998.

Institute of Medicine. Treating Drug Problems. Washington, D.C.: National Academy Press, 1990.

McLellan, A.T.; Grisson, G.; Durell, J.; Alterman, A.I.; Brill, P.; and O'Brien, C.P. Substance abuse treatment in the private setting: Are some programs more effective than others? Journal of Substance Abuse Treatment 10, 243-254, 1993.

Simpson, D.D. and Brown, B.S. Treatment retention and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4): 294-307, 1998.

Long-Term Residential Treatment

Long-Term Residential Treatment provides care 24 hours per day, generally in nonhospital settings. The best-known residential treatment model is the therapeutic community (TC), but residential treatment may also employ other models, such as cognitive-behavioral therapy.

TCs are residential programs with planned lengths of stay of 6 to 12 months. TCs focus on the "resocialization" of the individual and use the program's entire "community," including other residents, staff, and the social context, as active components of treatment. Addiction is viewed in the context of an individual's social and psychological deficits, and treatment focuses on developing personal accountability and responsibility and socially productive lives. Treatment is highly structured and can at times be confrontational, with activities designed to help residents examine damaging beliefs, self-concepts, and patterns of behavior and to adopt new, more harmonious and constructive ways to interact with others. Many TCs are quite comprehensive and can include employment training and other support services on site.

Therapeutic communities focus on the "resocialization" of the individual and use the program's entire "community" as active components of treatment.

Short-Term Residential Programs

Short-Term Residential Programs provide intensive but relatively brief residential treatment based on a modified 12-step approach. These programs were originally designed to treat alcohol problems, but during the cocaine epidemic of the mid-1980s, many began to treat illicit drug abuse and addiction. The original residential treatment model consisted of a 3 to 6-week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in a self-help group, such as Alcoholics Anonymous. Reduced health care coverage for substance abuse treatment has resulted in a diminished number of these programs, and the average length of stay under managed care review is much shorter than in early programs.

Further Reading:

Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; Anderson, J.; and Etheridge, R.M. Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4): 291-298, 1998.

Miller, M.M. Traditional approaches to the treatment of addiction. In: Graham A.W. and Schultz T.K., eds. Principles of Addiction Medicine, 2nd ed. Washington, D.C.: American Society of Addiction Medicine, 1998.

Medical Detoxification

is a process whereby individuals are systematically withdrawn from addicting drugs in an inpatient or outpatient setting, typically under the care of a physician. Detoxification is sometimes called a distinct treatment modality but is more appropriately considered a precursor of treatment, because it is designed to treat the acute physiological effects of stopping drug use. Medications are available for detoxification from opiates, nicotine, benzodiazepines, alcohol, barbiturates, and other sedatives. In some cases, particularly for the last three types of drugs, detoxification may be a medical necessity, and untreated withdrawal may be medically dangerous or even fatal.

Compared with patients in other forms of drug treatment, the typical TC resident has more severe problems, with more co-occurring mental health problems and more criminal involvement. Research shows that TCs can be modified to treat individuals with special needs, including adolescents, women, those with severe mental disorders, and individuals in the criminal justice system.

Further Reading:

Leukefeld, C.; Pickens, R.; and Schuster, C.R. Improving drug abuse treatment: Recommendations for research and practice. In: Pickens, R.W.; Luekefeld, C.G.; and Schuster, C.R., eds. Improving Drug Abuse Treatment, National Institute on Drug Abuse Research Monograph Series, DHHS Pub No. (ADM) 91-1754, U.S. Government Printing Office, 1991.

Lewis, B.F.; McCusker, J.; Hindin, R.; Frost, R.; and Garfield, F. Four residential drug treatment programs: Project IMPACT. In: Inciardi, J.A.; Tims, F.M.; and Fletcher, B.W. eds. Innovative Approaches in the Treatment of Drug Abuse. Westport, CN: Greenwood Press, 1993, pp. 45-60.

Sacks, S.; Sacks, J.; DeLeon, G.; Bernhardt, A.; and Staines, G. Modified therapeutic community for mentally ill chemical abusers: Background; influences; program description; preliminary findings. Substance Use and Misuse 32(9); 1217-1259, 1998.

Stevens, S.J., and Glider, P.J. Therapeutic communities: Substance abuse treatment for women. In: Tims, F.M.; De Leon, G.; and Jainchill, N., eds. Therapeutic Community: Advances in Research and Application, National Institute on Drug Abuse Research Monograph 144, NIH Pub. No. 94-3633, U.S. Government Printing Office, 1994, pp. 162-180.

Stevens, S.; Arbiter, N.; and Glider, P. Women residents: Expanding their role to increase treatment effectiveness in substance abuse programs. International Journal of the Addictions 24(5): 425-434, 1989.

Detoxification is a precursor of treatment.

Detoxification is not designed to address the psychological, social, and behavioral problems associated with addiction and therefore does not typically produce lasting behavioral changes necessary for recovery. Detoxification is most useful when it incorporates formal processes of assessment and referral to subsequent drug addiction treatment.

Further Reading:

Kleber, H.D. Outpatient detoxification from opiates. Primary Psychiatry 1: 42-52, 1996.

National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

Last updated September 27, 2006.

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