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Outpatient Drug Addiction Treatment and Alcohol Rehabilitation
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Drug Treatment Program History and Continuing Controversy

 

The phrase, drug treatment, is currently used to refer to treatment for problems with a wide array of substances including both illegal drugs and prescription medications. From the 1950’s through the 1970’s, however, drug treatment programs focused primarily on heroin and other opiates and were operated separately from programs focusing on alcohol. This division is reflected to this day in the fact that the federal government still maintains a National Institute on Drugs (NIDA) separate from the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Introduction of Outpatient Drug Treatment

During the 1980’s, when patients increasingly began to develop problems with a combination of alcohol and cocaine as well as other drugs, the division between drug treatment programs and alcohol treatment programs began to disappear. Thus programs, including Kolmac, that had previously been limited to working only with patients with alcohol problems, began to change into more comprehensive alcohol and drug treatment programs. Patients who had problems with only alcohol, only drugs, or both alcohol and drugs were treated together in an outpatient drug treatment setting.

The merging of these two treatment worlds into combined alcohol and drug treatment centers generally enriched both of them by introducing treatment approaches that were new to each group. One controversy did develop, however, and persists to this day. Drug treatment programs working with heroin and other opioids were divided into two camps. One was abstinence based, using residentially based therapeutic communities. The other, begun by Drs. Vincent Dole and Marie Nyswander in 1963, involved long term maintenance with the synthetic opiate, methadone.

The new comprehensive alcohol and drug treatment programs had a strong tradition of being abstinence based and did not welcome methadone maintained patients. This tension has been exacerbated since buprenorphine has become available. The comprehensive programs have increasingly been willing to use buprenorphine briefly as a detoxification medication, but have been resistant to using it for more extended periods of stabilization.

Because of the absence of available data to resolve this controversy, the staff at Kolmac conducted a study of our own patients at our outpatient drug treatment centers in Maryland and Washington, D.C. When buprenorphine became available in 2003, we were impressed by how much greater treatment success resulted when patients continued to take the medication for a period of time rather than simply using it for detoxification. These patients were integrated into our program which was otherwise abstinence based. We were able to demonstrate that the improvement by the buprenorphine stabilized patients did not occur at the expense of the rest of the patients. Specifically, the percentage of non-opioid patients successfully completing the program increased since the buprenorphine patients were integrated, as compared to the period prior to 2003 when the opioid antagonist, naltrexone, was given to opioid addicted patients to assure that they would remain abstinent. These findings were presented at the annual conventions of the American Psychiatric Association in 2006 and the American Society of Addiction Medicine in 2007.

On the basis of this positive experience, Kolmac has become an active advocate for such an integration of these patients to become a more standard practice in the residential and outpatient drug treatment community.

 

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