A number of treatment approaches and techniques have been developed and used for management of drug abuse and alcoholism during the last 50 years in the United States. These treatment methods have been categorized based on the treatment settings (outpatient, short-term residential, long-term residential) or based on treatment techniques [pharmacological or nonpharmacological (behavioral, psychosocial)]. The relative effectiveness and appropriateness of these treatments has always been an issue of concern to health policy, and decision makers, treatment providers and the users. For example, naltrexone, a long acting orally effective opioid antagonist, has been tried in patients of opioid or alcohol dependence. In controlled clinical studies, the drug has shown positive effects when added to counseling. It is reported to significantly reduce heavy drinking in patients who are willing to take the drug as prescribed. However, the beneficial effects of naltrexone are limited due to the serious problem of noncompliance or lack of willingness of patients to continue it for sufficient duration. Buprenorphine is an opioid agonist-antagonist effective for the treatment of opiate abuse besides its analgesic indication in patients with advanced painful cancer. Three national studies evaluating drug abuse treatment programs have been carried out to evaluate the suitability of the different outpatient treatment programs. However, methodological differences used in these programs have been a limitation to arrive at solid conclusions. Furthermore, the treatment modalities also varied as they evolved across time and change in their components. The client characteristics changed across last 3 decades particularly regarding the drug of abuse. The admission to specific treatment modalities depended on client criteria based on admission guidelines in force from time to time. These variations may limit the comparability of treatment outcome across these studies and across different treatment modalities, though adequate measures have been taken during analysis to minimize these limitations. Despite these limitations, some generalizations about the effectiveness of outpatient treatment can be made from the findings that have been consistent across studies. Outpatient drug-free treatment program is effective in reducing drug abuse and in improving other parameters like criminality and employment. Furthermore, it is effective as methadone maintenance; however, it is less effective than long-term residential treatment program. The program is effective primarily if patients receive treatment for 3 months or longer.
*Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Hampton House, Room 759, Baltimore 21205, MD
†Department of Clinical Pharmacology, Muhimbili University College of Health Sciences (MUCHS), PO Box 65010, Dar-es-Salaam, Tanzania, East Africa
Reprints: Dr Stephen E. D. Nsimba, DDS, MSc, PhD, Department of Clinical Pharmacology, Muhimbili University College of Health Sciences (MUCHS), PO Box 65010, Dar-es-Salaam, Tanzania, East Africa (e-mails: firstname.lastname@example.org; email@example.com).