Patients who use illicit drugs benefit from treatment if they recognize that their substance use is a problem. The transtheoretical model considers a patient on a continuum from precontemplation (denial) toward maintenance (abstinence/recovery).
The clinical approach should be tailored to the patient's readiness to change behavior and enter treatment. For all abused drugs, medical follow-up after any acute toxic presentation is essential to address substance abuse issues and possible coexisting medical and psychiatric problems.
[...] The major goals of drug abuse treatment are detoxification, abstinence initiation, and relapse prevention. Treatment can be pharmacologic and nonpharmacologic. Pharmacologic approaches are offered by physicians specializing in addiction and increasingly by primary care physicians. Some form of psychosocial treatment is the backbone of substance abuse treatment, be it psychotherapy, behavioral therapy, or counseling. Issues addressed in these encounters include teaching coping skills, changing reinforcement contingencies, fostering management of painful effects, addressing motivation, improving interpersonal functioning, enhancing social supports, and encouraging compliance with and retention in pharmacotherapy. [...]
[...] Prevention of relapse to active heroin abuse has been attempted most commonly by substitution of a safer drug (e.g., methadone, buprenorphine, or the second-line agent, l-acetyl-a-methadol) with similar pharmacologic properties to relieve the craving and withdrawal and to block some of the euphoric effects of heroin. These medications (i.e., high-dose methadone [60 to 100 buprenorphine [16 to 32 and levomethadyl acetate [75 to 115 substantially reduced use of illicit opioids compared with low-dose methadone (20 mg) in a randomized controlled trial. [...]
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