Let's continue to talk about treatment. Treatment for drug abuse and addiction is critical and even if someone is convinced that he or she can walk away from drugs, it can't hurt to get some guidance from a professional. Because treatment is so essential, many people have done a lot of thinking about it. There are a number of principles that are related to effective treatment. Let's go over those in more detail. The first thing is to realize, is that professionals are available and facilities exist to help those who can't seem to get away from drugs by themselves. Individual vary in age, in severity of addiction, and in having coexisting problems. Treatment must be flexible enough to effectively deal with the various kinds of individuals. Drug abuse is complex. As I have said before, treatment must address this complexity. Treatment certainly should be available to those that need it, and making sure that enough money has been invested by society to make it available is of utmost importance. As treatment progresses, the needs of the patient may change. They may go from emergency and intensive care, to dealing with a sustained level of drug use. Or, once someone gets drug use under control, they may need job training or other kinds of activities to improve their lives. Thus, treatment may need to change and evolve as the process of recovery changes and evolves. Subjects need to remain in treatment for an adequate period of time. In general, treatment works and the chances that it will work with a specific person can depend on how much time is spent in treatment. Some studies suggest that perhaps more than three months in treatment is needed to get control of drug taking and to get the most out of treatment. Counseling can also help produce needed behavioral changes. The individual may have to eliminate something they're doing, such as hanging out with drug users. Or, they may have to add some things that they aren't doing, such as finding rewards and fun without bad consequences. Medications must be considered. It's clear that medications can help with the complexity of drug abuse. Medications can be especially useful in reducing craving. Coexisting, or what we refer to as comorbid problems, have to be addressed. Frequently, problems other than drug use exist, that enhance drug use. The coexistence of such a problem along with the drug problem, may make both problems worse. Sometimes people think that they only need to go through distressing withdrawal to stop the craving in the group of drugs. Going through withdrawal is referred to as detoxification. It's important to know that detox is a good starting treatment, but it's only a start. As you know, brain imaging has shown that the brain is changed for a long time and that the healing process is slow. To avoid relapse, treatment must be extended and included in li, in your life after detox. Some people say that you have to want to get off drugs to get off drugs. You need to want to get to clean for treatment to work. However, this seems to be an urban myth. Treatment does not to be voluntary to work. Court mandated treatment also works and this is important to realize. [BLANK_AUDIO] As someone progresses in treatment, his or her drug use must be monitored. This is the only way that we can concretely and objectively assess the patient's progress. Relapses are common but are not indicative of a total failure. Treatment can be resumed, and even though there may be relapses, they are, that is not a reason to give up hope. Drug users are sometimes unhealthy, make bad choices, and have poor judgment. Accordingly, drug users often are the carriers of some serious diseases, like AIDS, hepatitis or sexually transmitted diseases. Someone in treatment for drug abuse needs to made aware of this aspect of the problem. Treatment should assess and treat these problems as well, should the patient require it. I mentioned earlier that you have to remain in treatment for an adequate period of time, perhaps three months or more. This can translate into recovery requiring multiple episodes of treatment. People who do not give up and return to treatment when needed, sometimes again and again, do the best in recovering from drug use. And finally, it's all confidential. One doesn't have to worry that they're going to lose their job and be stigmatized forever because they're in treatment. Rather, the opposite is true. Unless they get a grip on their drug problem, they may have to deal with a prison record, failed relationships, and those won't be confidential. And they have the chance of stigmatizing and ruining a life. There are different kinds of professional helpers in the drug addiction area, with a broad range of training. Addiction psychiatrists are medical doctors and are capable of treating serious comorbid disorders. Family doctors and nurses can be involved in treatment and are often the first to realize that a patient needs treatment. Psychologists and social workers can be very effective counselors. Religious leaders in the community can also be very helpful. Drug court judges can be important because they are there to intervene at a potentially serious event in an addict's life. They have the authority to make sure individuals get the treatment they need, and treatment can be required if necessary. I'll discuss more about drug courts later. So, we've mentioned that there are many treatment principles that have been established, that there are different kinds of treatment professionals, and now we can look at the different approaches to treatment. As we've said before, drug use is complex and treatment has to address this complexity and may need to be complex. There needs to be many approaches. I mentioned detoxification, which is going through withdrawal. It gets drugs out of the body and allows one to begin to regain some stability in their life. Treatment can be inpatient where the patient enters the facility, or it can be outpatient where time is spent with a treatment professional, but then the patient leaves the facility. The seriousness or the severity of the addiction, coexisting or comor, comorbid problems, and other issues, will determine which is best. Long-term counseling and medications are a mainstay in treatment. The counseling can, can include several kinds of therapy, such as cognitive behavioral therapy. The medications can include medicines like methadone, which is used to reduce craving for opiates. There are 12-step programs that have good results for those who stick with these programs. And there are other approaches to treatment. I'm just providing some examples, so that you'll get an idea of what happens. And don't forget, prevention is the best treatment. Don't get started with drugs at all. Let's say a little bit more about medications. They can prevent relapse and reduce craving. There are medications for opiates, and these include methadone, buprenorphine and naltrexone. Each of these drugs are slightly different and might be used for different types of patients. Medications for tobacco include the nicotine patch, spray, gum and lozenges. Nicotine replacement controls craving and the desire to smoke. Additional drugs to control smoking include bupropion and varenicline. To treat alcohol abuse, medications include naltrexone, which reduces the drive to take alcohol, and acamprosate and disulfiram. Because medications are so impactful, many researchers spend a great deal of time trying to find new medications and new strategies to develop medications. Let's talk about vaccines, vaccines for drugs of abuse. Vaccines against drugs have attracted a lot of attention. They are more or less a new approach to treat drug use, and there have been successes in both animal and human studies. But more development is needed. They're not yet ready for widespread use in the treatment of addiction. Vaccines have some interesting proble, properties that can make them advantageous over other existing medications. One, is that a treatment, which is an injection to produce antibodies would have long lasting effects. Months. Whereas a dose of a medication is likely to last only several hours. Medications have to get into the brain to have their medicating effect. Because they have to get into the brain, they can have side effects of their own. But antibodies from vaccinations do not have to enter the brain to work. They work in the blood, and therefore, antibodies do not have side effects like medications do. Let's go over how antibodies work. If you do not have antibodies in your blood and you take a drug, the drug will get into your blood and eventually get into the brain, where it's going to have its effect. But if you have been given a vaccine, which stimulates your immune system to create antibodies, the antibodies in your blood will bind the drugs in your blood and prevent them from getting to the brain. As I said, both human and animal studies indicate that vaccines and antibodies can reduce drug use and drug reward. But, better vaccines are needed to give more people benefit. This story's not over yet. Let's return to a more general discussion of treatment. What is successful treatment? Many professionals agree that success is defined as at least partly reducing the harm in your life by a reduction in drug use. Total abstinence of the drug is the best and ideal outcome. Relapse may occur, but that does not create a total failure. It merely indicates that treatment must be continued or perhaps adjusted somewhat. Reduction of harm, or some harm, is a success. No discussion about treatment would be complete without addressing the cost of treatment. As you can imagine, many studies have looked at the cost of treating drug addicts. According to several conservative estimates, every dollar invested in treatment yields a return of between 4 and $7, in reduced, drug related crime, criminal justice cost and theft. When savings to healthcare are included, the total savings due to treatment can exceed costs by a ratio of 12 to one. Major additional savings to the individual and to the society also stem from fewer interpersonal conflicts, greater workplace productivity, and fewer drug-related accidents, such as overdoses and deaths. Treatment does not cost us in the normal sense, it actually saves and reduces overall cost. Here is an exercise. Go to the Internet or some kind of directory that is available to you for your particular locale, and find treatment programs. Can you tell if they adhere to the treatment principles described in this lecture? You can learn about the availability of treatment in your area, and how you could be involved to improve it.
