In order to break the cycle of chronic drug use, drug-dependent individuals must make important changes in their life styles and attitudes and usually need help in doing so. Behavioral and psychosocial treatments are the cornerstone of service available to help drug abusers achieve and sustain meaningful periods of abstinence. However, research efforts in this important area have remained relatively stagnant in relation to the pace of research on biological and molecular bases of drug dependence and medications development. To address this discrepancy, NIDA has recently initiated a program to encourage development and testing of innovative behavioral and psychosocial therapies as well as systematic testing of existing therapies. Recent advances resulting from this effort are summarized below: Opiate abusers frequently receive treatment in methadone programs, where behavioral/ psychosocial therapies are combined with a medication to control heroin use. Their other illicit drug use, especially cocaine, is often a primary target of behavioral interventions.
Treatment of Opiate Abusers:
Treatment of Cocaine Abusers:
Treatment of primary cocaine abusers relies entirely on behavior and psychosocial therapies because there have been no effective medications discovered to date.
- Community Reinforcement therapy is a powerful new behavioral treatment for cocaine abuse. The treatment combines couples counseling, recreational therapy and tangible incentives (retail items) that help to motivate abstinence. The treatment retains patients in treatment (e.g. 58% retained for 24 weeks compared with 11% of controls) and promotes long durations of sustained abstinence
- Relapse prevention therapy, which teaches patients to recognize high-risk situations for drug use and to implement coping strategies, has also shown promise for treatment of cocaine abusers. Rates of retention and abstinence have been better for relapse prevention than for control therapy in two studies.
Treatment of Tobacco Smokers:
Many smokers who would like to stop prefer to do it on their own with no professional help. However, less than 10% of smokers who try to quit succeed on any given quit attempt.
- Research has identified specific physiological, psychological and environmental factors that lead to relapse versus successful abstinence after quitting. Treatments can be tailored to address these factors.
- Research has shown that the most effective method for smoking cessation combines nicotine replacement with patch or gum and behavior therapy that teaches patients to recognize high-risk situations for smoking and to implement coping strategies. 30-40% can achieve long-term abstinence with this approach on a given quit attempt.
- Smokers with a history of depression have an especially hard time quitting. Research has now shown that these smokers can benefit from a special mood management therapy in combination with nicotine replacement.
The College on Problems of Drug Dependence is the leading scientific society in the drug abuse field. Founded in 1929 as part of the National Academy of Sciences, CPDD in now an independent organization promoting scientific research on drug abuse problems. As a service to the academic community and policy makers, CPDD offers updates on recent advances that have implications for future research and public health agendas.