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`Treatment Approaches for Drug Addiction
`
`NOTE: This fact sheet discusses research findings on effective treatment approaches for
`drug abuse and addiction. If you’re seeking treatment, you can call the Substance Abuse and
`Mental Health Services Administration's (SAMHSA's) National Helpline at 1-800-662-HELP
`(1-800-662-4357) or go to www.findtreatment.samhsa.gov for information on hotlines,
`counseling services, or treatment options in your state.
`
`What is drug addiction?
`
`Drug addiction is a chronic disease characterized by compulsive, or uncontrollable, drug
`seeking and use despite harmful consequences and changes in the brain, which can be
`long lasting. These changes in the brain can lead to the harmful behaviors seen in people
`who use drugs. Drug addiction is also a relapsing disease. Relapse is the return to drug
`use after an attempt to stop.
`
`The path to drug addiction begins with
`the voluntary act of taking drugs. But
`over time, a person's ability to choose
`not to do so becomes compromised.
`Seeking and taking the drug becomes
`compulsive. This is mostly due to the
`effects of long-term drug exposure on
`brain function. Addiction affects parts of
`the brain involved in reward and
`motivation, learning and memory, and
`control over behavior.
`
`Addiction is a disease that affects both
`the brain and behavior.
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`©iStock/Evgeny Sergeev/
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`Treatment Approaches for Drug Addiction • January 2018 • Page 1
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`ALKERMES EXHIBIT 2004
`Amneal Pharmaceuticals LLC v. Alkermes Pharma Ireland Limited
`IPR2018-00943
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`Can drug addiction be treated?
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`Yes, but it’s not simple. Because addiction is a chronic disease, people can’t simply stop
`using drugs for a few days and be cured. Most patients need long-term or repeated care
`to stop using completely and recover their lives.
`
`Addiction treatment must help the person do the following:
`• stop using drugs
`• stay drug-free
`• be productive in the family, at work, and in society
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`Principles of Effective Treatment
`Based on scientific research since the mid-1970s, the following key principles should form
`the basis of any effective treatment program:
`• Addiction is a complex but treatable disease that affects brain function and behavior.
`• No single treatment is right for everyone.
`• People need to have quick access to treatment.
`• Effective treatment addresses all of the patient’s needs, not just his or her drug use.
`• Staying in treatment long enough is critical.
`• Counseling and other behavioral therapies are the most commonly used
`forms of treatment.
`• Medications are often an important part of treatment, especially when combined
`with behavioral therapies.
`• Treatment plans must be reviewed often and modified to fit the patient’s
`changing needs.
`• Treatment should address other possible mental disorders.
`• Medically assisted detoxification is only the first stage of treatment.
`• Treatment doesn't need to be voluntary to be effective.
`• Drug use during treatment must be monitored continuously.
`• Treatment programs should test patients for HIV/AIDS, hepatitis B and C,
`tuberculosis, and other infectious diseases as well as teach them about steps they
`can take to reduce their risk of these illnesses.
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`What are treatments for drug addiction?
`
`There are many options that have been successful in treating drug addiction, including:
`• behavioral counseling
`• medication 
`• medical devices and applications used to treat withdrawal symptoms or deliver
`skills training
`• evaluation and treatment for co-occurring mental health issues such as
`depression and anxiety
`long-term follow-up to prevent relapse
`
`A range of care with a tailored treatment program and follow-up options can be crucial to
`success. Treatment should include both medical and mental health services as needed.
`
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`•
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`Follow-up care may include community- or family-based recovery support systems.
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`How are medications and devices used in drug addiction treatment?
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`Medications and devices can be used to manage withdrawal symptoms, prevent relapse,
`and treat co- occurring conditions.
`
`
`Withdrawal. Medications and devices can help suppress withdrawal symptoms during
`detoxification. Detoxification is not in itself "treatment," but only the first step in the
`process. Patients who do not receive any further treatment after detoxification usually
`resume their drug use. One study of treatment facilities found that medications were
`used in almost 80 percent of detoxifications (SAMHSA, 2014). Devices are also being used
`to reduce withdrawal symptoms. In November 2017, the Food and Drug Administration
`(FDA) granted a new indication to an electronic stimulation device, NSS-2 Bridge, for use
`in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and
`sends electrical pulses to stimulate certain brain nerves.
`
`Relapse prevention. Patients can use medications to help re-establish normal brain
`function and decrease cravings. Medications are available for treatment of opioid (heroin,
`prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are
`developing other medications to treat stimulant (cocaine, methamphetamine) and
`cannabis (marijuana) addiction. People who use more than one drug, which is very
`common, need treatment for all of the substances they use.
`• Opioids: Methadone (Dolophine®, Methadose®), buprenorphine (Suboxone®,
`Subutex®, Probuphine® , Sublocade™), and naltrexone (Vivitrol®) are used to
`treat opioid addiction. Acting on the same targets in the brain as heroin and
`morphine, methadone and buprenorphine suppress withdrawal symptoms and
`relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in
`the brain and should be used only in patients who have already been detoxified.
`All medications help patients reduce drug seeking and related criminal behavior
`and help them become more open to behavioral treatments. A NIDA study found
`that once treatment is initiated, both a buprenorphine/naloxone combination and
`an extended release naltrexone formulation are similarly effective in treating
`opioid addiction. Because full detoxification is necessary for treatment with
`naloxone, initiating treatment among active users was difficult, but once
`detoxification was complete, both medications had similar effectiveness.
`• Tobacco: Nicotine replacement therapies have several forms, including the patch,
`spray, gum, and lozenges. These products are available over the counter. The U.S.
`Food and Drug Administration (FDA) has approved two prescription medications
`for nicotine addiction: bupropion (Zyban®) and varenicline (Chantix®). They
`work differently in the brain, but both help prevent relapse in people trying to
`quit. The medications are more effective when combined with behavioral
`treatments, such as group and individual therapy as well as telephone quitlines.
`• Alcohol: Three medications have been FDA-approved for treating alcohol
`addiction and a fourth, topiramate, has shown promise in clinical trials (large-
`scale studies with people). The three approved medications are as follows:
`o Naltrexone blocks opioid receptors that are involved in the rewarding
`effects of drinking and in the craving for alcohol. It reduces relapse to
`heavy drinking and is highly effective in some patients. Genetic differences
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`may affect how well the drug works in certain patients.
`o Acamprosate (Campral®) may reduce symptoms of long-lasting
`withdrawal, such as insomnia, anxiety, restlessness, and dysphoria
`(generally feeling unwell or unhappy). It may be more effective in patients
`with severe addiction.
`o Disulfiram (Antabuse®) interferes with the breakdown of alcohol.
`Acetaldehyde builds up in the body, leading to unpleasant reactions that
`include flushing (warmth and redness in the face), nausea, and irregular
`heartbeat if the patient drinks alcohol. Compliance (taking the drug as
`prescribed) can be a problem, but it may help patients who are highly
`motivated to quit drinking.
`• Co-occuring conditions: Other medications are available to treat possible mental
`health conditions, such as depression or anxiety, that may be contributing to the
`person’s addiction.
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`How are behavioral therapies used to treat drug addiction?
`Behavioral therapies help patients:
`• modify their attitudes and behaviors related to drug use
`•
`increase healthy life skills
`• persist with other forms of treatment, such as medication
`
`Patients can receive treatment in many different settings with various approaches.
`
`Outpatient behavioral treatment includes a wide variety of programs for patients who
`visit a behavioral health counselor on a regular schedule. Most of the programs involve
`individual or group drug counseling, or both. These programs typically offer forms of
`behavioral therapy such as:
`• cognitive-behavioral therapy, which helps patients recognize, avoid, and cope with
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`the situations in which they are most likely to use drugs
`• multidimensional family therapy—developed for adolescents with drug abuse
`problems as well as their families—which addresses a range of influences on their
`drug abuse patterns and is designed to improve overall family functioning
`• motivational interviewing, which makes the most of people's readiness to change
`their behavior and enter treatment
`• motivational incentives (contingency management), which uses positive
`reinforcement to encourage abstinence from drugs
`
`Treatment is sometimes intensive at first, where patients attend multiple outpatient
`sessions each week. After completing intensive treatment, patients transition to regular
`outpatient treatment, which meets less often and for fewer hours per week to help
`sustain their recovery. In September 2017, the FDA permitted marketing of the first
`mobile application, reSET®, to help treat substance use disorders. This application is
`intended to be used with outpatient treatment to treat alcohol, cocaine, marijuana, and
`stimulant substance use disorders.
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`Inpatient or residential treatment can also be very effective, especially for those with
`more severe problems (including co-occurring disorders). Licensed residential treatment
`facilities offer 24-hour structured and intensive care, including safe housing and medical
`attention. Residential treatment facilities may use a variety of therapeutic approaches, and
`they are generally aimed at helping the patient live a drug-free, crime-free lifestyle after
`treatment. Examples of residential treatment settings include:
`• Therapeutic communities, which are highly structured programs in which patients
`remain at a residence, typically for 6 to 12 months. The entire community,
`including treatment staff and those in recovery, act as key agents of change,
`influencing the patient’s attitudes, understanding, and behaviors associated with
`drug use. Read more about therapeutic communities in the Therapeutic
`Communities Research Report at https://www.drugabuse.gov/publications/
`research-reports/therapeutic-communities.
`• Shorter-term residential treatment, which typically focuses on detoxification as
`well as providing initial intensive counseling and preparation for treatment in a
`community-based setting.
`• Recovery housing, which provides supervised, short-term housing for patients,
`often following other types of inpatient or residential treatment. Recovery housing
`can help people make the transition to an independent life—for example, helping
`them learn how to manage finances or seek
`employment, as well as connecting them to support
`services in the community.
`
`Challenges of Re-entry
`Drug abuse changes the function
`of the brain, and many things can
`"trigger" drug cravings within the
`brain. It’s critical for those in
`treatment, especially those
`treated at an inpatient facility or
`prison, to learn how to
`recognize, avoid, and cope with
`triggers they are likely to be
`exposed to after treatment.
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`Is treatment different for criminal justice populations?
`
`Scientific research since the mid-1970s shows that
`drug abuse treatment can help many drug-using
`offenders change their attitudes, beliefs, and
`behaviors towards drug abuse; avoid relapse; and
`successfully remove themselves from a life of
`substance abuse and crime. Many of the principles
`of treating drug addiction are similar for people
`within the criminal justice system as for those in
`
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`the general population. However, many offenders don’t have access to the types of
`services they need. Treatment that is of poor quality or is not well suited to the needs of
`offenders may not be effective at reducing drug use and criminal behavior.
`
`In addition to the general principles of treatment, some considerations specific to
`offenders include the following:
`• Treatment should include development of specific cognitive skills to
`help the offender adjust attitudes and beliefs that lead to drug abuse and
`crime, such as feeling entitled to have things one’s own way or not
`understanding the consequences of one’s behavior. This includes skills related
`to thinking, understanding, learning, and remembering.
`• Treatment planning should include tailored services within the correctional
`facility as well as transition to community-based treatment after release.
`• Ongoing coordination between treatment providers and courts or parole and
`probation officers is important in addressing the complex needs of offenders re-
`entering society.
`
`How many people get treatment for drug addiction?
`
`According to SAMHSA's National Survey on Drug Use and Health, 22.5 million people (8.5
`percent of the U.S. population) aged 12 or older needed treatment for an illicit* drug or
`alcohol use problem in 2014. Only 4.2 million (18.5 percent of those who needed
`treatment) received any substance use treatment in the same year. Of these, about 2.6
`million people received treatment at specialty treatment programs (CBHSQ, 2015).
`
`*The term "illicit" refers to the use of illegal drugs, including marijuana according to federal law, and misuse of
`prescription medications.
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`Points to Remember
`• Drug addiction can be treated, but it’s not simple. Addiction treatment must help the person
`do the following:
`o stop using drugs
`o stay drug-free
`o be productive in the family, at work, and in society
`• Successful treatment has several steps:
`o detoxification
`o behavioral counseling
`o medication (for opioid, tobacco, or alcohol addiction)
`o evaluation and treatment for co-occurring mental health issues such as depression
`and anxiety
`long-term follow-up to prevent relapse
`o
`• Medications and devices can be used to manage withdrawal symptoms, prevent relapse,
`and treat co-occurring conditions.
`• Behavioral therapies help patients:
`o modify their attitudes and behaviors related to drug use
`increase healthy life skills
`o
`o persist with other forms of treatment, such as medication
`• People within the criminal justice system may need additional treatment services to treat drug
`use disorders effectively. However, many offenders don’t have access to the types of services
`they need.
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`Learn More
`
`For more information about drug addiction treatment, visit:
`www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-
`guide-third-edition/acknowledgments
`
`For information about drug addiction treatment in the criminal justice system, visit:
`www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-
`populations/principles
`
`For step-by-step guides for people who think they or a loved one may need treatment, visit:
`www.drugabuse.gov/related-topics/treatment
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`This publication is available for your use and may be reproduced in its entirety without
`permission from NIDA. Citation of the source is appreciated, using the following language:
`
`Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of
`Health and Human Services.
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`Updated January 2018
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`References
`
`Center for Behavioral Health Statistics and Quality (CBSHQ). 2014 National Survey on Drug Use and
`Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration;
`2015.
`
`Substance Abuse and Mental Health Services Administration (SAMHSA). National Survey of
`Substance Abuse Treatment Services (N-SSATS): 2013. Data on Substance Abuse Treatment Facilities.
`Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014. HHS Publication
`No. (SMA) 14-489. BHSIS Series S-73.
`
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