I

National Institute on Drug Abuse

National Institutes of Health

U.S. Department of Health and Human Services

principles of

drug addiction

treatment

A research-based guide

second edition
II
National Institute on Drug Abuse

National Institutes of Health

U.S. Department of Health and Human Services

principles of

drug addiction

treatment

A research-based guide

second edition
iiii

Martin W. Adler, Ph.D.

Temple University School of Medicine

Andrea G. Barthwell, M.D.

Encounter Medical Group

Kathleen Brady, M.D., Ph.D.

Medical University of South Carolina

Greg Brigham, Ph.D.

Maryhaven

Lawrence S. Brown, Jr., M.D., M.P.H.

Addiction Research and 

Treatment Corporation

James F. Callahan, D.P.A.

American Society of 

Addiction Medicine

Kathleen M. Carroll, Ph.D.

Yale University School of Medicine

H. Westley Clark, M.D., J.D., 

M.P.H., CAS, FASAM

Center for Substance Abuse Treatment

Richard R. Clayton, Ph.D.

University of Kentucky

Linda B. Cottler, Ph.D.

Washington University 

School of Medicine

David P. Friedman, Ph.D.

Bowman Gray School of Medicine

Reese T. Jones, M.D.

University of California at San Francisco

Linda R. Wolf-Jones, D.S.W.

Therapeutic Communities of America

Linda Kaplan, CAE

National Association of Alcoholism 

and Drug Abuse Counselors

A. Thomas McLellan, Ph.D.

University of Pennsylvania 

School of Medicine

G. Alan Marlatt, Ph.D.

University of Washington

Nancy K. Mello, Ph.D.

Harvard Medical School

William R. Miller, Ph.D.

University of New Mexico

Charles P. O’Brien, M.D., Ph.D.

University of Pennsylvania

Jeffrey Seltzer, M.D.

Zucker Hillside Hospital

Eric J. Simon, Ph.D.

New York University Medical Center

Jose Szapocznik, Ph.D.

University of Miami 

Miller School of Medicine

George Woody, M.D.

University of Pennsylvania 

The National Institute on Drug Abuse wishes to thank the following 

individuals for reviewing this publication.

All materials in this volume are in the public domain and may be used 

or reproduced without permission from the Institute or the authors. 

Citation of the source is appreciated. 

The U.S. Government does not endorse or favor any specific commercial

product or company. Trade, proprietary, or company names appearing in 

this publication are used only because they are considered essential in the

context of the studies described. 

NIH Publication No. 09–4180

Printed October 1999; Reprinted July 2000, February 2008; Revised April 2009

Acknowledgments
Contents iii

ii Acknowledgments

v Preface

2 Principles of Effective Treatment

7 Frequently Asked Questions

7 Why do drug-addicted persons keep using drugs?

8 What is drug addiction treatment?

11 How effective is drug addiction treatment?

12 Is drug addiction treatment worth its cost?

14 How long does drug addiction 

treatment usually last?

14 What helps people stay in treatment?

15 How do we get more substanceabusing people into treatment?

16 How can families and friends make a difference 

in the life of someone needing treatment?

16 Where can family members go for 

information on treatment options?

18 How can the workplace play a role 

in substance abuse treatment?

18 What role can the criminal justice system 

play in addressing drug addiction?

20 What are the unique needs of women 

with substance use disorders?

20 What are the unique needs of adolescents 

with substance use disorders?

21 Are there specific drug addiction 

treatments for older adults?
iv

22 Are there treatments for people 

addicted to prescription drugs?

23 Is there a difference between physical 

dependence and addiction?

23 Can a person become addicted to psychotherapeutics 

that are prescribed by a doctor?

24 How do other mental disorders coexisting with 

drug addiction affect drug addiction treatment?

24 Is the use of medications like methadone 

and buprenorphine simply replacing 

one drug addiction with another?

25 Where do 12-step or self-help programs 

fit into drug addiction treatment?

26 Can exercise play a role in the treatment process?

26 How does drug addiction treatment help 

reduce the spread of HIV/AIDS, hepatitis 

C (HCV), and other infectious diseases?

29 Drug Addiction Treatment 

in the United States

30 General Categories of Treatment Programs

35 Treating Criminal Justice-Involved Drug 

Abusers and Addicted Individuals

37 Evidence-Based Approaches to 

Drug Addiction Treatment

37 Pharmacotherapies

46 Behavioral Therapies

63 Resources
v

Drug addiction is a complex illness. It is characterized by intense and, at times, 

uncontrollable drug craving, along with compulsive 

drug seeking and use that persist even in the face of 

devastating consequences. 

Many people do not realize that addiction is a brain 

disease. While the path to drug addiction begins with 

the act of taking drugs, over time a person’s ability to 

choose not to do so becomes compromised, and seeking 

and consuming the drug becomes compulsive. This 

behavior results largely from the effects of prolonged drug 

exposure on brain functioning. Addiction affects multiple 

brain circuits, including those involved in reward and 

motivation, learning and memory, and inhibitory control 

over behavior. Some individuals are more vulnerable 

than others to becoming addicted, depending on genetic 

makeup, age of exposure to drugs, other environmental 

influences, and the interplay of all these factors.

Addiction is often more than just compulsive drug 

taking—it can also produce far-reaching consequences. 

For example, drug abuse and addiction increase a 

person’s risk for a variety of other mental and physical 

illnesses related to a drug-abusing lifestyle or the toxic 

effects of the drugs themselves. Additionally, a wide 

range of dysfunctional behaviors can result from drug 

abuse and interfere with normal functioning in the 

family, the workplace, and the broader community.

Because drug abuse and addiction have so many 

dimensions and disrupt so many aspects of an individual’s 

life, treatment is not simple. Effective treatment programs 

typically incorporate many components, each directed 

to a particular aspect of the illness and its consequences. 

Addiction treatment must help the individual stop 

using drugs, maintain a drug-free lifestyle, and achieve 

productive functioning in the family, at work, and in 

society. Because addiction is a disease, people cannot 

Preface
vi

simply stop using drugs for a few days and be cured. Most 

patients require long-term or repeated episodes of care 

to achieve the ultimate goal of sustained abstinence and 

recovery of their lives.

Indeed, scientific research and clinical practice 

demonstrate the value of continuing care in treating 

addiction, with a variety of approaches having been tested 

and integrated in residential and community settings. As 

we look toward the future, we will harness new research 

results on the influence of genetics and environment on 

gene function and expression (i.e., epigenetics), which 

are heralding the development of personalized treatment 

interventions. These findings will be integrated with 

current evidence supporting the most effective drug abuse 

and addiction treatments and their implementation, which 

are reflected in this guide.

This update of the National Institute on Drug Abuse’s 

Principles of Drug Addiction Treatment is intended to address 

addiction to a wide variety of drugs, including nicotine, 

alcohol, and illicit and prescription drugs. It is designed 

to serve as a resource for health care providers, family 

members, and other stakeholders trying to address the 

myriad problems faced by patients in need of treatment 

for drug abuse or addiction.

Nora D. Volkow, M.D.

Director

National Institute on Drug Abuse
1

Three decades of scientific research 

and clinical practice have yielded 

a variety of effective approaches to 

drug addiction treatment.
2

Principles 

of Effective 

Treatment

1. Addiction is a complex but treatable 

disease that affects brain function and 

behavior. Drugs of abuse alter the brain’s structure 

and function, resulting in changes that persist long after 

drug use has ceased. This may explain why drug abusers 

are at risk for relapse even after long periods of abstinence 

and despite the potentially devastating consequences.

2. No single treatment is appropriate 

for everyone. Matching treatment settings, 

interventions, and services to an individual’s particular 

problems and needs is critical to his or her ultimate 

success in returning to productive functioning in the 

family, workplace, and society.

3. Treatment needs to be readily available. 

Because drug-addicted individuals may be uncertain 

about entering treatment, taking advantage of available 

services the moment people are ready for treatment 

is critical. Potential patients can be lost if treatment is 

not immediately available or readily accessible. As with 

other chronic diseases, the earlier treatment is offered 

in the disease process, the greater the likelihood of 

positive outcomes.

4. Effective treatment attends to multiple 

needs of the individual, not just his 

or her drug abuse. To be effective, treatment 

must address the individual’s drug abuse and any 

associated medical, psychological, social, vocational, 

and legal problems. It is also important that treatment 

be appropriate to the individual’s age, gender, ethnicity, 

and culture.

5. Remaining in treatment for an adequate 

period of time is critical. The appropriate 

duration for an individual depends on the type and degree 

of his or her problems and needs. Research indicates 

that most addicted individuals need at least 3 months in 

treatment to significantly reduce or stop their drug use 

2
3

and that the best outcomes occur with longer durations 

of treatment. Recovery from drug addiction is a longterm process and frequently requires multiple episodes of 

treatment. As with other chronic illnesses, relapses to drug 

abuse can occur and should signal a need for treatment to 

be reinstated or adjusted. Because individuals often leave 

treatment prematurely, programs should include strategies 

to engage and keep patients in treatment.

6. Counseling—individual and/or group—

and other behavioral therapies are the 

most commonly used forms of drug 

abuse treatment. Behavioral therapies vary in their 

focus and may involve addressing a patient’s motivation 

to change, providing incentives for abstinence, building 

skills to resist drug use, replacing drug-using activities 

with constructive and rewarding activities, improving 

problemsolving skills, and facilitating better interpersonal 

relationships. Also, participation in group therapy and 

other peer support programs during and following 

treatment can help maintain abstinence.

7. Medications are an important element of 

treatment for many patients, especially 

when combined with counseling and 

other behavioral therapies. For example, 

methadone and buprenorphine are effective in helping 

individuals addicted to heroin or other opioids stabilize 

their lives and reduce their illicit drug use. Naltrexone 

is also an effective medication for some opioid-addicted 

individuals and some patients with alcohol dependence. 

Other medications for alcohol dependence include 

acamprosate, disulfiram, and topiramate. For persons 

addicted to nicotine, a nicotine replacement product 

(such as patches, gum, or lozenges) or an oral medication 

(such as bupropion or varenicline) can be an effective 

component of treatment when part of a comprehensive 

behavioral treatment program.

3
4

8. An individual’s treatment and services 

plan must be assessed continually and 

modified as necessary to ensure that 

it meets his or her changing needs. 

A patient may require varying combinations of services 

and treatment components during the course of treatment 

and recovery. In addition to counseling or psychotherapy, 

a patient may require medication, medical services, family 

therapy, parenting instruction, vocational rehabilitation, 

and/or social and legal services. For many patients, a 

continuing care approach provides the best results, with 

the treatment intensity varying according to a person’s 

changing needs.

9. Many drug-addicted individuals also 

have other mental disorders. Because 

drug abuse and addiction—both of which are mental 

disorders—often co-occur with other mental illnesses, 

patients presenting with one condition should be assessed 

for the other(s). And when these problems co-occur, 

treatment should address both (or all), including the use of 

medications as appropriate.

10. Medically assisted detoxification is only 

the first stage of addiction treatment 

and by itself does little to change 

long-term drug abuse. Although medically 

assisted detoxification can safely manage the acute 

physical symptoms of withdrawal and, for some, can 

pave the way for effective long-term addiction treatment, 

detoxification alone is rarely sufficient to help addicted 

individuals achieve long-term abstinence. Thus, patients 

should be encouraged to continue drug treatment 

following detoxification. Motivational enhancement and 

incentive strategies, begun at initial patient intake, can 

improve treatment engagement.

4
5

11. Treatment does not need to be 

voluntary to be effective. Sanctions or 

enticements from family, employment settings, and/or the 

criminal justice system can significantly increase treatment 

entry, retention rates, and the ultimate success of drug 

treatment interventions.

12. Drug use during treatment must be 

monitored continuously, as lapses 

during treatment do occur. Knowing their 

drug use is being monitored can be a powerful incentive 

for patients and can help them withstand urges to use 

drugs. Monitoring also provides an early indication of a 

return to drug use, signaling a possible need to adjust an 

individual’s treatment plan to better meet his or her needs. 

13. Treatment programs should assess 

patients for the presence of HIV/

AIDS, hepatitis B and C, tuberculosis, 

and other infectious diseases as well 

as provide targeted risk-reduction 

counseling to help patients modify 

or change behaviors that place them 

at risk of contracting or spreading 

infectious diseases. Typically, drug abuse 

treatment addresses some of the drug-related behaviors 

that put people at risk of infectious diseases. Targeted 

counseling specifically focused on reducing infectious 

disease risk can help patients further reduce or avoid 

substance-related and other high-risk behaviors. 

Counseling can also help those who are already infected 

to manage their illness. Moreover, engaging in substance 

abuse treatment can facilitate adherence to other medical 

treatments. Patients may be reluctant to accept screening 

for HIV (and other infectious diseases); therefore, it is 

incumbent upon treatment providers to encourage and 

support HIV screening and inform patients that highly 

active antiretroviral therapy (HAART) has proven 

effective in combating HIV, including among drugabusing populations.
6 Treatment varies depending on the 

type of drug and the characteristics 

of the patient. The best programs 

provide a combination of therapies 

and other services.
7

1. Why do drug-addicted persons keep 

using drugs?

Nearly all addicted individuals believe at the outset that 

they can stop using drugs on their own, and most try 

to stop without treatment. Although some people are 

successful, many attempts result in failure to achieve longterm abstinence. Research has shown that long-term drug 

abuse results in changes in the brain that persist long after 

a person stops using drugs. These drug-induced changes 

in brain function can have many behavioral consequences, 

including an inability to exert control over the impulse 

to use drugs despite adverse consequences—the defining 

characteristic of addiction. 

Long-term drug use results in significant 

changes in brain function that can 

persist long after the individual stops 

using drugs. 

Understanding that addiction has such a fundamental 

biological component may help explain the difficulty 

of achieving and maintaining abstinence without 

treatment. Psychological stress from work, family problems, 

psychiatric illness, pain associated with medical problems, 

social cues (such as meeting individuals from one’s drugusing past), or environmental cues (such as encountering 

streets, objects, or even smells associated with drug abuse) 

can trigger intense cravings without the individual even 

being consciously aware of the triggering event. Any 

one of these factors can hinder attainment of sustained 

abstinence and make relapse more likely. Nevertheless, 

research indicates that active participation in treatment is 

an essential component for good outcomes and can benefit 

even the most severely addicted individuals.

Frequently Asked 

Questions
2. What is drug addiction treatment?

Drug treatment is intended to help addicted individuals 

stop compulsive drug seeking and use. Treatment can 

occur in a variety of settings, in many different forms, and 

for different lengths of time. Because drug addiction is 

typically a chronic disorder characterized by occasional 

relapses, a short-term, one-time treatment is usually not 

sufficient. For many, treatment is a long-term process that 

involves multiple interventions and regular monitoring. 

There are a variety of evidence-based approaches to 

treating addiction. Drug treatment can include behavioral 

therapy (such as individual or group counseling, cognitive 

therapy, or contingency management), medications, or 

their combination. The specific type of treatment or 

combination of treatments will vary depending on the 

The best treatment programs provide a combination of therapies 

and other services to meet the needs of the individual patient.

Components of Comprehensive Drug Abuse Treatment

HIV/AIDS

Services

Educational Services

Child Care

Services

Financial

Services Medical

Services

Housing / Transportation Services

Mental Health Services

Family

Services Vocational

Services

Legal

Services

Intake Processing/

Assessment

Treatment Plan

Pharmacotherapy

Continuing Care

Clinical 

and Case

Management

Behavioral 

Therapy and 

Counseling

Substance Use Monitoring

Self-Help/Peer 

Support Groups

8
9

patient’s individual needs and, often, on the types of drugs 

they use. The severity of addiction and previous efforts to 

stop using drugs can also influence a treatment approach. 

Finally, people who are addicted to drugs often suffer from 

other health (including other mental health), occupational, 

legal, familial, and social problems that should be 

addressed concurrently. 

The best programs provide a combination of therapies 

and other services to meet an individual patient’s needs. 

Specific needs may relate to age, race, culture, sexual 

orientation, gender, pregnancy, other drug use, comorbid 

conditions (e.g., depression, HIV), parenting, housing, and 

employment, as well as physical and sexual abuse history. 

Drug addiction treatment can include 

medications, behavioral therapies, or 

their combination. 

Treatment medications, such as methadone, 

buprenorphine, and naltrexone, are available for 

individuals addicted to opioids, while nicotine preparations 

(patches, gum, lozenges, and nasal spray) and the 

medications varenicline and bupropion are available for 

individuals addicted to tobacco. Disulfiram, acamprosate, 

naltrexone, and topiramate are medications used for 

treating alcohol dependence, which commonly co-occurs 

with other drug addictions. In fact, most people with 

severe addiction are polydrug users and require treatment 

for all substances abused. Even combined alcohol and 

tobacco use has proven amenable to concurrent treatment 

for both substances.

Psychoactive medications, such as antidepressants, 

antianxiety agents, mood stabilizers, and antipsychotic 

medications, may be critical for treatment success when 

patients have co-occurring mental disorders, such as 

depression, anxiety disorders (including post-traumatic 

stress disorder), bipolar disorder, or schizophrenia. 
10

Behavioral therapies can help motivate people to 

participate in drug treatment; offer strategies for coping 

with drug cravings; teach ways to avoid drugs and prevent 

relapse; and help individuals deal with relapse if it 

occurs. Behavioral therapies can also help people improve 

communication, relationship, and parenting skills, as well 

as family dynamics. 

Many treatment programs employ both individual 

and group therapies. Group therapy can provide 

social reinforcement and help enforce behavioral 

contingencies that promote abstinence and a non-drugusing lifestyle. Some of the more established behavioral 

treatments, such as contingency management and 

cognitive-behavioral therapy, are also being adapted 

for group settings to improve efficiency and costeffectiveness. However, particularly in adolescents, there 

can also be a danger of iatrogenic, or inadvertent, 

effects of group treatment; thus, trained counselors 

should be aware and monitor for such effects. 

Because they work on different aspects of addiction, 

combinations of behavioral therapies and medications 

(when available) generally appear to be more effective 

than either approach used alone.

Treatment for drug abuse and addiction 

is delivered in many different settings 

using a variety of behavioral and 

pharmacological approaches. 
11

3. How effective is drug addiction 

treatment?

In addition to stopping drug abuse, the goal of treatment 

is to return people to productive functioning in the family, 

workplace, and community. According to research that 

tracks individuals in treatment over extended periods, 

most people who get into and remain in treatment stop 

using drugs, decrease their criminal activity, and improve 

their occupational, social, and psychological functioning. 

For example, methadone treatment has been shown to 

increase participation in behavioral therapy and decrease 

both drug use and criminal behavior. However, individual 

treatment outcomes depend on the extent and nature of 

the patient’s problems, the appropriateness of treatment 

and related services used to address those problems, and 

the quality of interaction between the patient and his or 

her treatment providers. 

DRUG ADDICTION

TYPE I DIABETES

30 to 50%

40 to 60%

HYPERTENSION

50 to 70%

ASTHMA

50 to 70%

Percentage of Patients Who Relapse

Comparison of Relapse Rates 

Between Drug Addiction and 

Other Chronic Illnesses
12

Relapse rates for addiction resemble 

those of other chronic diseases such 

as diabetes, hypertension, and asthma. 

Like other chronic diseases, addiction can be managed 

successfully. Treatment enables people to counteract 

addiction’s powerful disruptive effects on the brain and 

behavior and to regain control of their lives. The chronic 

nature of the disease means that relapsing to drug abuse is 

not only possible but also likely, with relapse rates similar 

to those for other well-characterized chronic medical 

illnesses—such as diabetes, hypertension, and asthma 

(see figure, “Comparison of Relapse Rates Between Drug 

Addiction and Other Chronic Illnesses”)—that also have 

both physiological and behavioral components. 

Unfortunately, when relapse occurs many deem treatment 

a failure. This is not the case: successful treatment for 

addiction typically requires continual evaluation and 

modification as appropriate, similar to the approach taken 

for other chronic diseases. For example, when a patient is 

receiving active treatment for hypertension and symptoms 

decrease, treatment is deemed successful, even though 

symptoms may recur when treatment is discontinued. For 

the addicted patient, lapses to drug abuse do not indicate 

failure—rather, they signify that treatment needs to be 

reinstated or adjusted, or that alternate treatment is 

needed (see figure, “How Do We Evaluate if a Treatment 

is Effective?”).

4. Is drug addiction treatment worth 

its cost?

Substance abuse costs our Nation over one half-trillion 

dollars annually, and treatment can help reduce these 

costs. Drug addiction treatment has been shown to reduce 

associated health and social costs by far more than the 

cost of the treatment itself. Treatment is also much less 
13

expensive than its alternatives, such as incarcerating 

addicted persons. For example, the average cost for 

1 full year of methadone maintenance treatment is 

approximately $4,700 per patient, whereas 1 full year of 

imprisonment costs approximately $24,000 per person.

Drug addiction treatment reduces 

drug use and its associated health 

and social costs.

According to several conservative estimates, every $1 

invested in addiction treatment programs yields a return 

of between $4 and $7 in reduced drug-related crime, 

criminal justice costs, and theft. When savings related to 

health care are included, total savings can exceed costs 

by a ratio of 12 to 1. Major savings to the individual and 

to society also stem from fewer interpersonal conflicts; 

greater workplace productivity; and fewer drug-related 

accidents, including overdoses and deaths.

8

7

6

5

4

3

2

1

0

8

7

6

5

4

3

2

1

0

How Do We Evaluate if a Treatment is Effective? SEVERITY OF CONDITION

STAGE OF TREATMENT

PRE DURING POST PRE DURING POST

Hypertension Treatment Addiction Treatment

YES!!! NO???
14

5. How long does drug addiction 

treatment usually last? 

Individuals progress through drug addiction treatment 

at various rates, so there is no predetermined length of 

treatment. However, research has shown unequivocally 

that good outcomes are contingent on adequate treatment 

length. Generally, for residential or outpatient treatment, 

participation for less than 90 days is of limited effectiveness, 

and treatment lasting significantly longer is recommended for 

maintaining positive outcomes. For methadone maintenance, 

12 months is considered the minimum, and some opioidaddicted individuals continue to benefit from methadone 

maintenance for many years.

Good outcomes are contingent on 

adequate treatment length.

Treatment dropout is one of the major problems 

encountered by treatment programs; therefore, motivational 

techniques that can keep patients engaged will also improve 

outcomes. By viewing addiction as a chronic disease and 

offering continuing care and monitoring, programs can 

succeed, but this will often require multiple episodes of 

treatment and readily readmitting patients that have relapsed.

6. What helps people stay in treatment?

Because successful outcomes often depend on a person’s 

staying in treatment long enough to reap its full benefits, 

strategies for keeping people in treatment are critical. 

Whether a patient stays in treatment depends on factors 

associated with both the individual and the program. 

Individual factors related to engagement and retention 

typically include motivation to change drug-using behavior; 

degree of support from family and friends; and, frequently, 
15

pressure from the criminal justice system, child protection 

services, employers, or the family. Within a treatment 

program, successful clinicians can establish a positive, 

therapeutic relationship with their patients. The clinician 

should ensure that a treatment plan is developed 

cooperatively with the person seeking treatment, that 

the plan is followed, and that treatment expectations 

are clearly understood. Medical, psychiatric, and social 

services should also be available.

Whether a patient stays in treatment 

depends on factors associated with 

both the individual and the program.

Because some problems (such as serious medical or 

mental illness or criminal involvement) increase the 

likelihood of patients dropping out of treatment, intensive 

interventions may be required to retain them. After a 

course of intensive treatment, the provider should ensure 

a transition to less intensive continuing care to support 

and monitor individuals in their ongoing recovery.

7. How do we get more substanceabusing people into treatment?

It has been known for many years that the “treatment 

gap” is massive—that is, among those who need treatment 

for a substance use disorder, few receive it. In 2007, 

23.2 million persons aged 12 or older needed treatment for 

an illicit drug or alcohol use problem, but only 3.9 million 

received treatment at a specialty substance abuse facility.
16

Reducing this gap requires a multipronged approach. 

Strategies include increasing access to effective treatment, 

achieving insurance parity (now in its earliest phase of 

implementation), reducing stigma, and raising awareness 

among both patients and health care professionals of 

the value of addiction treatment. To assist physicians in 

identifying treatment need in their patients and making 

appropriate referrals, NIDA is encouraging widespread use 

of screening, brief intervention, and referral to treatment 

(SBIRT) tools for use in primary care settings. SBIRT—

which has proven effective against tobacco and alcohol 

use—has the potential not only to catch people before 

serious drug problems develop but also to connect them 

with appropriate treatment providers.

8. How can families and friends make 

a difference in the life of someone 

needing treatment?

Family and friends can play critical roles in motivating 

individuals with drug problems to enter and stay in 

treatment. Family therapy can also be important, 

especially for adolescents. Involvement of a family 

member or significant other in an individual’s treatment 

program can strengthen and extend treatment benefits.

9. Where can family members go for 

information on treatment options?

Trying to locate appropriate treatment for a loved one, 

especially finding a program tailored to an individual’s 

particular needs, can be a difficult process. However, there 

are some resources currently available to help with this 

process, including—
17

• The Substance Abuse and Mental Health Services 

Administration (SAMHSA) maintains a Web site 

(www.findtreatment.samhsa.gov) that shows the location 

of residential, outpatient, and hospital inpatient 

treatment programs for drug addiction and alcoholism 

throughout the country. This information is also 

accessible by calling 1-800-662-HELP.

• The National Suicide Prevention Lifeline 

(1-800-273-TALK) offers more than just suicide 

prevention—it can also help with a host of issues, 

including drug and alcohol abuse, and can connect 

individuals with a nearby professional. 

• The National Alliance on Mental Illness (www.nami.org) 

and Mental Health America (www.mentalhealthamerica.net) 

are alliances of nonprofit, self-help support 

organizations for patients and families dealing with a 

variety of mental disorders. Both have State and local 

affiliates throughout the country and may be especially 

helpful for patients with comorbid conditions.

• The American Academy of Addiction Psychiatry and 

the American Academy of Child and Adolescent 

Psychiatry each have physician locator tools posted 

on their Web sites at www.aaap.org and www.aacap.org, 

respectively.

• For information about participating in a clinical trial 

testing promising substance abuse interventions, contact 

NIDA’s National Drug Abuse Treatment Clinical Trials 

Network at www.drugabuse.gov/CTN/Index.htm, or visit 

NIH’s Web site at www.clinicaltrials.gov. 
18

10. How can the workplace play a role 

in substance abuse treatment?

Many workplaces sponsor Employee Assistance Programs 

(EAPs) that offer short-term counseling and/or assistance 

in linking employees with drug or alcohol problems to 

local treatment resources, including peer support/recovery 

groups. In addition, therapeutic work environments that 

provide employment for drug-abusing individuals who 

can demonstrate abstinence have been shown not only to 

promote a continued drug-free lifestyle but also to improve 

job skills, punctuality, and other behaviors necessary for 

active employment throughout life. Urine testing facilities, 

trained personnel, and workplace monitors are needed to 

implement this type of treatment.

11. What role can the criminal justice 

system play in addressing drug 

addiction?

Research has demonstrated that treatment for drugaddicted offenders during and after incarceration can have 

a significant effect on future drug use, criminal behavior, 

and social functioning. The case for integrating drug 

addiction treatment approaches with the criminal justice 

system is compelling. Combining prison- and communitybased treatment for addicted offenders reduces the risk 

of both recidivism to drug-related criminal behavior and 

relapse to drug use, which, in turn, nets huge savings 

in societal costs. One study found that prisoners who 

participated in a therapeutic treatment program in the 

Delaware State prison system and continued to receive 

treatment in a work-release program after prison were 70 

percent less likely than nonparticipants to return to drug 

use and incur re-arrest.
19

Individuals who enter treatment 

under legal pressure have outcomes 

as favorable as those who enter 

treatment voluntarily.

The majority of offenders involved with the criminal 

justice system are not in prison but are under community 

supervision. For those with known drug problems, 

drug addiction treatment may be recommended or 

mandated as a condition of probation. Research has 

demonstrated that individuals who enter treatment under 

legal pressure have outcomes as favorable as those who 

enter treatment voluntarily.

The criminal justice system refers drug offenders into 

treatment through a variety of mechanisms, such as 

diverting nonviolent offenders to treatment; stipulating 

treatment as a condition of incarceration, probation, or 

pretrial release; and convening specialized courts, or 

drug courts, that handle drug offense cases. These courts 

mandate and arrange for treatment as an alternative to 

incarceration, actively monitor progress in treatment, and 

arrange for other services for drug-involved offenders.

The most effective models integrate criminal justice and 

drug treatment systems and services. Treatment and 

criminal justice personnel work together on treatment 

planning—including implementation of screening, 

placement, testing, monitoring, and supervision—as 

well as on the systematic use of sanctions and rewards. 

Treatment for incarcerated drug abusers should include 

continuing care, monitoring, and supervision after 

incarceration and during parole. (For more information, 

please see NIDA’s Principles of Drug Abuse Treatment 

for Criminal Justice Populations: A Research-Based Guide

[revised 2007].)
20

12. What are the unique needs 

of women with substance 

use disorders?

Gender-related drug abuse treatment should attend 

not only to biological differences but also to social and 

environmental factors, all of which can influence the 

motivations for drug use, the reasons for seeking treatment, 

the types of environments where treatment is obtained, the 

treatments that are most effective, and the consequences 

of not receiving treatment. Many life circumstances 

predominate in women as a group, which may require 

a specialized treatment approach. For example, research 

has shown that physical and sexual trauma followed by 

post-traumatic stress disorder (PTSD) is more common 

in drug-abusing women than in men seeking treatment. 

Other factors unique to women that can influence the 

treatment process include issues around pregnancy and 

child care, financial independence, and how they come 

into treatment (as women are more likely to seek the 

assistance of a general or mental health practitioner).

13. What are the unique needs of 

adolescents with substance 

use disorders?

Adolescent drug abusers have unique needs stemming 

from their immature neurocognitive and psychosocial 

stage of development. Research has demonstrated that 

the brain undergoes a prolonged process of development 

and refinement, from birth to early adulthood, during 

which a developmental shift occurs where actions go 

from more impulsive to more reasoned and reflective. 

In fact, the brain areas most closely associated with aspects 

of behavior such as decisionmaking, judgment, planning, 

and self-control undergo a period of rapid development 

during adolescence.
21

Adolescent drug abuse is also often associated with 

other co-occurring mental health problems. These 

include attention-deficit hyperactivity disorder (ADHD), 

oppositional defiant disorder, and conduct problems, 

as well as depressive and anxiety disorders. This 

developmental period has also been associated with 

physical and/or sexual abuse and academic difficulties.

Adolescents are also especially sensitive to social cues, with 

peer groups and families being highly influential during 

this time. Therefore, treatments that facilitate positive 

parental involvement, integrate other systems in which the 

adolescent participates (such as school and athletics), and 

recognize the importance of prosocial peer relationships 

are among the most effective. Access to comprehensive 

assessment, treatment, case management, and familysupport services that are developmentally, culturally, and 

gender-appropriate is also integral when addressing 

adolescent addiction.

Medications for substance abuse among adolescents 

may also be helpful. Currently, the only Food and Drug 

Administration (FDA)-approved addiction medication 

for adolescents is the transdermal nicotine patch. 

Research is under way to determine the safety and 

efficacy of medications for nicotine-, alcohol-, and 

opioid-dependent adolescents and for adolescents with 

co-occurring disorders.

14. Are there specific drug addiction 

treatments for older adults?

With the aging of the baby boomer generation, the 

composition of the general population will expand 

dramatically with respect to the number of older adults. 

Such a change, coupled with a greater history of lifetime 

drug use (than previous older generations), different 

cultural norms and general attitudes about drug use, 
22

and increases in the availability of psychotherapeutic 

medications, may lead to growth in the number of older 

adults with substance use problems. Although no drug 

treatment programs are yet designed exclusively for older 

adults, research to date indicates that current addiction 

treatment programs can be as effective for older adults 

as they are for younger adults. However, substance abuse 

problems in older adults often go unrecognized, and 

therefore untreated.

15. Are there treatments for people 

addicted to prescription drugs?

The nonmedical use of prescription drugs increased 

dramatically in the 1990s and remains at high levels. In 

2007, approximately 7 million people aged 12 or older 

reported nonmedical use of a prescription drug. The most 

commonly abused medications are painkillers (i.e., opioids: 

5.2 million people), stimulants (e.g., methylphenidate and 

amphetamine: 1.2 million), and central nervous system 

(CNS) depressants (e.g., benzodiazepines: 2.1 million). Like 

many illicit substances, these drugs alter the brain’s activity 

and can lead to many adverse consequences, including 

addiction. For example, opioid pain relievers, such as 

Vicodin or OxyContin, can present similar health risks as 

do illicit opioids (e.g., heroin) depending on dose, route 

of administration, combination with other drugs, and 

other factors. As a result, the increases in nonmedical use 

have been accompanied by increased emergency room 

visits, accidental poisonings, and treatment admissions for 

addiction. Treatments for prescription drugs tend to be 

similar to those for illicit drugs that affect the same brain 

systems. Thus, buprenorphine is used to treat addiction 

to opioid pain medications, and behavioral therapies are 

most likely to be effective for stimulant or CNS depressant 

addiction—for which we do not yet have medications.
23

16. Is there a difference between 

physical dependence and addiction? 

Yes. According to the DSM, the clinical criteria for “drug 

dependence” (or what we refer to as addiction) include 

compulsive drug use despite harmful consequences; 

inability to stop using a drug; failure to meet work, social, 

or family obligations; and, sometimes (depending on 

the drug), tolerance and withdrawal. The latter reflect 

physical dependence in which the body adapts to the 

drug, requiring more of it to achieve a certain effect 

(tolerance) and eliciting drug-specific physical or mental 

symptoms if drug use is abruptly ceased (withdrawal). 

Physical dependence can happen with the chronic use 

of many drugs—including even appropriate, medically 

instructed use. Thus, physical dependence in 

and of itself does not constitute addiction, but 

often accompanies addiction. This distinction can be 

difficult to discern, particularly with prescribed pain 

medications, where the need for increasing dosages can 

represent tolerance or a worsening underlying problem, 

as opposed to the beginning of abuse or addiction.

17. Can a person become addicted 

to psychotherapeutics that are 

prescribed by a doctor?

While this scenario occurs infrequently, it is possible. 

Because some psychotherapeutics have a risk of addiction 

associated with them (e.g., stimulants to treat ADHD, 

benzodiazepines to treat anxiety or sleep disorders, 

and opioids to treat pain), it is important for patients 

to follow their physician’s instructions faithfully and for 

physicians to monitor their patients carefully. To minimize 

these risks, a physician (or other prescribing health 

provider) should be aware of a patient’s prior or current 

substance abuse problems, as well as their family history 

with regard to addiction. This will help determine risk 

and need for monitoring.
24

18. How do other mental disorders 

coexisting with drug addiction 

affect drug addiction treatment?

Drug addiction is a disease of the brain that frequently 

occurs with other mental disorders. In fact, as many as 

6 in 10 people with an illicit substance use disorder also 

suffer from another mental illness; and rates are similar 

for users of licit drugs—i.e., tobacco and alcohol. For 

these individuals, one condition becomes more difficult to 

treat successfully as an additional condition is intertwined. 

Thus, patients entering treatment either for a substance 

use disorder or for another mental disorder should be 

assessed for the co-occurrence of the other condition. 

Research indicates that treating both (or multiple) illnesses 

simultaneously in an integrated fashion is generally the 

best treatment approach for these patients.

19. Is the use of medications like 

methadone and buprenorphine 

simply replacing one drug 

addiction with another? 

No—as used in maintenance treatment, buprenorphine 

and methadone are not heroin/opioid substitutes. 

They are prescribed or administered under monitored, 

controlled conditions and are safe and effective for 

treating opioid addiction when used as directed. They are 

administered orally or sublingually (i.e., under the tongue) 

in specified doses, and their pharmacological effects differ 

from those of heroin and other abused opioids. 

Heroin, for example, is often injected, snorted, or smoked, 

causing an almost immediate “rush,” or brief period of 

euphoria, that wears off quickly and ends in a “crash.” 

The individual then experiences an intense craving to use 

again so as to stop the crash and reinstate the euphoria. 
25

The cycle of euphoria, crash, and craving—sometimes 

repeated several times a day—is a hallmark of addiction 

and results in severe behavioral disruption. These 

characteristics result from heroin’s rapid onset and short 

duration of action in the brain.

As used in maintenance treatment, 

methadone and buprenorphine are 

not heroin/opioid substitutes.

In contrast, methadone and buprenorphine have 

gradual onsets of action and produce stable levels of 

the drug in the brain; as a result, patients maintained 

on these medications do not experience a rush, while 

they also markedly reduce their desire to use opioids. 

If an individual treated with these medications 

tries to take an opioid such as heroin, the euphoric 

effects are usually dampened or suppressed. Patients 

undergoing maintenance treatment do not experience 

the physiological or behavioral abnormalities from 

rapid fluctuations in drug levels associated with heroin 

use. Maintenance treatments save lives—they help to 

stabilize individuals, allowing treatment of their medical, 

psychological, and other problems so they can contribute 

effectively as members of families and of society.

20. Where do 12-step or selfhelp programs fit into 

drug addiction treatment?

Self-help groups can complement and extend the 

effects of professional treatment. The most prominent 

self-help groups are those affiliated with Alcoholics 

Anonymous (AA), Narcotics Anonymous (NA), and 

Cocaine Anonymous (CA), all of which are based on the 

12-step model. Most drug addiction treatment programs 
26

encourage patients to participate in self-help group 

therapy during and after formal treatment. These groups 

can be particularly helpful during recovery, offering an 

added layer of community-level social support to help 

people achieve and maintain abstinence and other healthy 

lifestyle behaviors over the course of a lifetime.

21. Can exercise play a role in 

the treatment process?

Yes—exercise is increasingly becoming a component 

of many treatment programs and has shown efficacy, 

in combination with cognitive-behavioral therapy, for 

promoting smoking cessation. Exercise may exert 

beneficial effects by addressing psychosocial and 

physiological needs that nicotine replacement alone 

does not; attenuating negative affect; reducing stress; 

and helping prevent weight gain following cessation. 

Research is currently under way to determine if and 

how exercise programs can play a similar role in the 

treatment of other forms of drug abuse.

22. How does drug addiction treatment 

help reduce the spread of HIV/

AIDS, hepatitis C (HCV), and other 

infectious diseases?

Drug-abusing individuals, including injecting and 

non-injecting drug users, are at increased risk of HIV, 

HCV, and other infectious diseases. These diseases are 

transmitted by sharing contaminated drug injection 

equipment and by engaging in risky sexual behavior 

sometimes associated with drug use. Effective drug abuse 

treatment is HIV/HCV prevention because it reduces 

associated risk behaviors as well as drug abuse. Counseling 

that targets a range of HIV/HCV risk behaviors provides 

an added level of disease prevention.
27

Drug abuse treatment is HIV and 

HCV prevention.

Drug injectors who do not enter treatment are up to 

six times more likely to become infected with HIV than 

injectors who enter and remain in treatment because the 

latter reduce activities that can spread disease, such as 

sharing injection equipment and engaging in unprotected 

sexual activity. Participation in treatment also presents 

opportunities for screening, counseling, and referral to 

additional services, including early HIV treatment and 

access to HAART. In fact, HIV counseling and testing are 

key aspects of superior drug abuse treatment programs 

and should be offered to all individuals entering treatment. 

Greater availability of inexpensive and unobtrusive rapid 

HIV tests should increase access to these important aspects 

of HIV prevention and treatment.
28

Treatment for drug abuse and 

addiction is delivered in many different 

settings, using a variety of behavioral 

and pharmacological approaches.
29

Drug Addiction 

Treatment in the 

United States

Drug addiction is a complex disorder 

that can involve virtually every 

aspect of an individual’s functioning: 

in the family, at work and school, and 

in the community. Because of addiction’s 

complexity and pervasive consequences, drug addiction 

treatment typically must involve many components. 

Some of those components focus directly on the 

individual’s drug use; others, like employment training, 

focus on restoring the addicted individual to productive 

membership in the family and society (see diagram on 

page 8), enabling him or her to experience the rewards 

associated with abstinence.

Treatment for drug abuse and addiction is delivered in 

many different settings using a variety of behavioral 

and pharmacological approaches. In the United States, 

more than 13,000 specialized drug treatment facilities 

provide counseling, behavioral therapy, medication, case 

management, and other types of services to persons with 

substance use disorders.

Along with specialized drug treatment facilities, drug 

abuse and addiction are treated in physicians’ offices and 

mental health clinics by a variety of providers, including 

counselors, physicians, psychiatrists, psychologists, nurses, 

and social workers. Treatment is delivered in outpatient, 

inpatient, and residential settings. Although specific 

treatment approaches often are associated with particular 

treatment settings, a variety of therapeutic interventions or 

services can be included in any given setting.

Because drug abuse and addiction are major public 

health problems, a large portion of drug treatment is 

funded by local, State, and Federal governments. Private 

and employer-subsidized health plans also may provide 

coverage for treatment of addiction and its medical 

consequences. Unfortunately, managed care has resulted 

in shorter average stays, while a historical lack of or 

insufficient coverage for substance abuse treatment has 
30

curtailed the number of operational programs. The recent 

passage of parity for insurance coverage of mental health 

and substance abuse problems will hopefully improve this 

state of affairs. 

General Categories of 

Treatment Programs 

Research studies on addiction treatment typically have 

classified programs into several general types or modalities. 

Treatment approaches and individual programs continue 

to evolve and diversify, and many programs today do 

not fit neatly into traditional drug addiction treatment 

classifications. Examples of specific research-based 

treatment components are described on pages 30–35.

Detoxification and Medically Managed 

Withdrawal

Detoxification is the process by which the body clears itself 

of drugs and is often accompanied by unpleasant and 

sometimes even fatal side effects caused by withdrawal. As 

stated previously, detoxification alone does not address the 

psychological, social, and behavioral problems associated 

with addiction and therefore does not typically produce 

lasting behavioral changes necessary for recovery.

The process of detoxification often is managed with 

medications that are administered by a physician in an 

inpatient or outpatient setting; therefore, it is referred 

to as “medically managed withdrawal.” Detoxification 

is generally considered a precursor to or a first stage 

of treatment because it is designed to manage the 

acute and potentially dangerous physiological effects of 

stopping drug use. Medications are available to assist in 

the withdrawal from opioids, benzodiazepines, alcohol, 

nicotine, barbiturates, and other sedatives. Detoxification 

should be followed by a formal assessment and referral to 

subsequent drug addiction treatment.
31

Further Reading:

Kleber, H.D. Outpatient detoxification from opiates. 

Primary Psychiatry 1:42–52, 1996.

Long-Term Residential Treatment

Long-term residential treatment provides care 24 hours 

a day, generally in nonhospital settings. The best-known 

residential treatment model is the therapeutic community 

(TC), with planned lengths of stay between 6 and 12 

months. TCs focus on the “resocialization” of the 

individual and use the program’s entire community—

including other residents, staff, and the social context—

as active components of treatment. Addiction is viewed 

in the context of an individual’s social and psychological 

deficits, and treatment focuses on developing personal 

accountability and responsibility as well as socially 

productive lives. Treatment is highly structured and can 

be confrontational at times, with activities designed to 

help residents examine damaging beliefs, self-concepts, 

and destructive patterns of behavior and adopt new, 

more harmonious and constructive ways to interact with 

others. Many TCs offer comprehensive services, which can 

include employment training and other support services, 

on site. Research shows that TCs can be modified to 

treat individuals with special needs, including adolescents, 

women, homeless individuals, people with severe mental 

disorders, and individuals in the criminal justice system 

(see page 35).

Further Reading:

Lewis, B.F.; McCusker, J.; Hindin, R.; Frost, R.; and 

Garfield, F. Four residential drug treatment programs: 

Project IMPACT. In: J.A. Inciardi, F.M. Tims, and B.W. 

Fletcher (eds.), Innovative Approaches in the Treatment of Drug 

Abuse, Westport, CT: Greenwood Press, pp. 45–60, 1993.
32

Sacks, S.; Banks, S.; McKendrick, K.; and Sacks, J.Y. 

Modified therapeutic community for co-occurring 

disorders: A summary of four studies. Journal of Substance 

Abuse Treatment 34(1):112–122, 2008.

Sacks, S.; Sacks, J.; DeLeon, G.; Bernhardt, A.; and 

Staines, G. Modified therapeutic community for mentally 

ill chemical “abusers”: Background; influences; program 

description; preliminary findings. Substance Use and Misuse

32(9):1217–1259, 1997.

Stevens, S.J., and Glider, P.J. Therapeutic communities: 

Substance abuse treatment for women. In: F.M. Tims, 

G. DeLeon, and N. Jainchill (eds.), Therapeutic Community: 

Advances in Research and Application, National Institute 

on Drug Abuse Research Monograph 144, NIH Pub. 

No. 94–3633, U.S. Government Printing Office, 

pp. 162–180, 1994.

Sullivan, C.J.; McKendrick, K.; Sacks, S.; and Banks, S.M. 

Modified therapeutic community for offenders with MICA 

disorders: Substance use outcomes. American Journal of 

Drug and Alcohol Abuse 33(6):823–832, 2007.

Short-Term Residential Treatment

Short-term residential programs provide intensive but 

relatively brief treatment based on a modified 12‐step 

approach. These programs were originally designed to 

treat alcohol problems, but during the cocaine epidemic 

of the mid-1980s, many began to treat other types 

of substance use disorders. The original residential 

treatment model consisted of a 3–6-week hospital-based 

inpatient treatment phase followed by extended outpatient 

therapy and participation in a self-help group, such as 

Alcoholics Anonymous. Following stays in residential 

treatment programs, it is important for individuals to 

remain engaged in outpatient treatment programs and/

or aftercare programs. These programs help to reduce the 

risk of relapse once a patient leaves the residential setting.
33

Further Reading:

Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; 

Anderson, J.; and Etheridge, R.M. Overview of 1-year 

follow-up outcomes in the Drug Abuse Treatment 

Outcome Study (DATOS). Psychology of Addictive Behaviors

11(4):291–298, 1998.

Miller, M.M. Traditional approaches to the treatment 

of addiction. In: A.W. Graham and T.K. Schultz (eds.), 

Principles of Addiction Medicine (2nd ed.). Washington, D.C.: 

American Society of Addiction Medicine, 1998.

Outpatient Treatment Programs

Outpatient treatment varies in the types and intensity of 

services offered. Such treatment costs less than residential 

or inpatient treatment and often is more suitable for 

people with jobs or extensive social supports. It should 

be noted, however, that low-intensity programs may offer 

little more than drug education. Other outpatient models, 

such as intensive day treatment, can be comparable 

to residential programs in services and effectiveness, 

depending on the individual patient’s characteristics and 

needs. In many outpatient programs, group counseling 

can be a major component. Some outpatient programs 

are also designed to treat patients with medical or other 

mental health problems in addition to their drug disorders. 

Further Reading:

Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; 

Anderson, J.; and Etheridge, R.M. Overview of 1-year 

follow-up outcomes in the Drug Abuse Treatment 

Outcome Study (DATOS). Psychology of Addictive 

Behaviors 11(4):291–298, 1998.

Institute of Medicine. Treating Drug Problems. 

Washington, D.C.: National Academy Press, 1990.
34

McLellan, A.T.; Grisson, G.; Durell, J.; Alterman, 

A.I.; Brill, P.; and O’Brien, C.P. Substance 

abuse treatment in the private setting: Are some 

programs more effective than others? Journal of 

Substance Abuse Treatment 10:243–254, 1993.

Simpson, D.D., and Brown, B.S. Treatment retention 

and follow-up outcomes in the Drug Abuse Treatment 

Outcome Study (DATOS). Psychology of Addictive Behaviors

11(4):294–307, 1998.

Individualized Drug Counseling

Individualized drug counseling not only focuses on 

reducing or stopping illicit drug or alcohol use; it also 

addresses related areas of impaired functioning—such 

as employment status, illegal activity, and family/social 

relations—as well as the content and structure of the 

patient’s recovery program. Through its emphasis on 

short-term behavioral goals, individualized counseling 

helps the patient develop coping strategies and tools to 

abstain from drug use and maintain abstinence. The 

addiction counselor encourages 12-step participation (at 

least one or two times per week) and makes referrals for 

needed supplemental medical, psychiatric, employment, 

and other services.

Group Counseling

Many therapeutic settings use group therapy to capitalize 

on the social reinforcement offered by peer discussion and 

to help promote drug-free lifestyles. Research has shown 

that when group therapy either is offered in conjunction 

with individualized drug counseling or is formatted to 

reflect the principles of cognitive-behavioral therapy or 

contingency management, positive outcomes are achieved. 

Currently, researchers are testing conditions in which 

group therapy can be standardized and made more 

community-friendly.
35

Further Reading:

Crits-Christoph, P.; Gibbons, M.B.; Ring-Kurtz, S.; Gallop, 

R.; and Present, J. A pilot study of community-friendly 

manual-guided drug counseling. Journal of Substance Abuse 

Treatment; 2008 Nov. 26; [Epub ahead of print].

Crits-Christoph, P.; Siqueland, L.; Blaine, J.; Frank, A.; 

Luborsky, L.; Onken, L.S.; et al. Psychosocial treatments 

for cocaine dependence: National Institute on Drug Abuse 

Collaborative Cocaine Treatment Study. Archives of General 

Psychiatry 56(6):493–502, 1999.

Treating Criminal Justice–Involved Drug 

Abusers and Addicted Individuals

Research has shown that combining criminal justice 

sanctions with drug treatment can be effective in 

decreasing drug abuse and related crime. Individuals 

under legal coercion tend to stay in treatment longer and 

do as well as or better than those not under legal pressure. 

Often, drug abusers come into contact with the criminal 

justice system earlier than other health or social systems, 

presenting opportunities for intervention and treatment 

prior to, during, after, or in lieu of incarceration—which 

may ultimately interrupt and shorten a career of drug 

use. More information on how the criminal justice system 

can address the problem of drug addiction can be found 

in Principles of Drug Abuse Treatment for Criminal Justice 

Populations: A Research-Based Guide (National Institute on 

Drug Abuse, revised 2007).
36

Each approach to drug treatment is 

designed to address certain aspects of 

drug addiction and its consequences 

for the individual, family, and society.
37

This section presents several examples of treatment 

approaches and components that have an evidence base 

supporting their efficacy. Each approach is designed 

to address certain aspects of drug addiction and its 

consequences for the individual, family, and society. Some 

of the approaches are intended to supplement or enhance 

existing treatment programs, and others are fairly 

comprehensive in and of themselves.

The following is not a complete list of efficacious 

evidence-based treatment approaches. More are under 

development as part of our continuing support of 

treatment research.

Pharmacotherapies

Opioid Addiction

Methadone

Methadone maintenance treatment is usually conducted 

in specialized settings (e.g., methadone maintenance 

clinics). These specialized treatment programs offer the 

long-acting synthetic opioid medication methadone at a 

dosage sufficient to prevent opioid withdrawal, block the 

effects of illicit opioid use, and decrease opioid craving.

Combined with behavioral treatment: The most effective 

methadone maintenance programs include individual 

and/or group counseling, as well as provision of or 

referral to other needed medical, psychological, and 

social services. In a study that compared opioid-addicted 

individuals receiving only methadone to those receiving 

methadone coupled with counseling, individuals who 

received only methadone showed some improvement in 

reducing opioid use; however, the addition of counseling 

produced significantly more improvement, and the 

addition of onsite medical/psychiatric, employment, 

and family services further improved outcomes.

Evidence-Based 

Approaches to Drug 

Addiction Treatment
38

Further Reading:

Dole, V.P.; Nyswander, M.; and Kreek, M.J. Narcotic 

blockade. Archives of Internal Medicine 118:304–309, 1996.

McLellan, A.T.; Arndt, I.O.; Metzger, D.; Woody, 

G.E.; and O’Brien, C.P. The effects of psychosocial 

services in substance abuse treatment. JAMA

269(15):1953–1959, 1993.

Woody, G.E., et al. Psychotherapy for opiate addicts: Does 

it help? Archives of General Psychiatry 40:639–645, 1983.

Buprenorphine

Buprenorphine is a partial agonist (it has both agonist and 

antagonist properties) at opioid receptors that carries a 

low risk of overdose. It reduces or eliminates withdrawal 

symptoms associated with opioid dependence but does not 

produce the euphoria and sedation caused by heroin or 

other opioids.

In 2000, Congress passed the Drug Addiction Treatment 

Act, allowing qualified physicians to prescribe Schedule 

III, IV, and V medications for the treatment of opioid 

addiction. This created a major paradigm shift that 

allowed access to opioid treatment in general medical 

settings, such as primary care offices, rather than limiting 

it to specialized treatment clinics.

Buprenorphine was the first medication to be approved 

under the Drug Addiction Treatment Act and is 

available in two formulations: Subutex® (a pure form 

of buprenorphine) and the more commonly prescribed 

Suboxone® (a combination of buprenorphine and the 

opioid antagonist naloxone). The unique formulation with 

naloxone produces severe withdrawal symptoms when 

addicted individuals inject it to get high, lessening the 

likelihood of diversion.
39

Physicians who provide office-based buprenorphine 

treatment for detoxification and/or maintenance 

treatment must have special accreditation. These 

physicians are also required to have the capacity to 

provide counseling to patients when indicated or, if they 

do not, to refer patients to those who do.

Office-based treatment of opioid addiction is a costeffective approach that increases the reach of treatment 

and the options available to patients. Many patients have 

life circumstances that make office-based treatment a 

better option for them than specialty clinics. For example, 

they may live far away from treatment centers or have 

working hours incompatible with the clinic hours. Officebased addiction treatment is being offered by primary 

care physicians, psychiatrists, and other specialists, such as 

internists and pediatricians.

Patients stabilized on adequate, sustained dosages of 

methadone or buprenorphine can function normally. 

They can hold jobs, avoid the crime and violence of 

the street culture, and reduce their exposure to HIV by 

stopping or decreasing injection drug use and drug-related 

high-risk sexual behavior. Patients stabilized on these 

medications can also engage more readily in counseling 

and other behavioral interventions essential to recovery 

and rehabilitation.

Patients stabilized on adequate, sustained 

dosages of methadone or buprenorphine 

can hold jobs, avoid crime and violence, 

and reduce their exposure to HIV.

Further Reading:

Fiellin, D.A., et al. Counseling plus buprenorphinenaloxone maintenance therapy for opioid dependence. 

The New England Journal of Medicine 355(4):365–374, 2006.
40

Fudala P.J., et al. Buprenorphine/Naloxone Collaborative 

Study Group: Office-based treatment of opiate addiction 

with a sublingual-tablet formulation of buprenorphine 

and naloxone. The New England Journal of Medicine

349(10):949–958, 2003.

Kosten, T.R., and Fiellin, D.A. U.S. National 

Buprenorphine Implementation Program: Buprenorphine 

for office-based practice: Consensus conference overview. 

The American Journal on Addictions 13(Suppl. 1):S1–S7, 2004.

McCance-Katz, E.F. Office-based buprenorphine 

treatment for opioid-dependent patients. Harvard Review of 

Psychiatry 12(6):321–338, 2004.

Naltrexone

Naltrexone is a long-acting synthetic opioid antagonist 

with few side effects. An opioid antagonist blocks opioids 

from binding to their receptors and thereby prevents an 

addicted individual from feeling the effects associated 

with opioid use. Naltrexone as a treatment for opioid 

addiction is usually prescribed in outpatient medical 

settings, although initiation of the treatment often begins 

after medical detoxification in a residential setting. To 

prevent withdrawal symptoms, individuals must be 

medically detoxified and opioid-free for several days 

before taking naltrexone. The medication is taken orally 

either daily or three times a week for a sustained period. 

When used this way, naltrexone blocks all the effects, 

including euphoria, of self-administered opioids. The 

theory behind this treatment is that the repeated absence 

of the desired effects and the perceived futility of using 

the opioid will gradually diminish opioid craving and 

addiction. Naltrexone itself has no subjective effects (that 

is, a person does not perceive any particular drug effects) 

or potential for abuse, and it is not addictive. However, 

patient noncompliance is a common problem. Therefore, 
41

a favorable treatment outcome requires an accompanying 

positive therapeutic relationship, effective counseling or 

therapy, and careful monitoring of medication compliance. 

Many experienced clinicians have found naltrexone 

best suited for highly motivated, recently detoxified 

patients who desire total abstinence because of external 

circumstances. Professionals, parolees, probationers, and 

prisoners in work-release status exemplify this group.

Combined with behavioral treatment: Motivational incentives, 

such as the offering of prizes or rewards for maintaining 

abstinence, have been shown to enhance the treatment 

compliance and efficacy of naltrexone for opioid addiction.

Further Reading:

Carroll, K.M., et al. Targeting behavioral therapies 

to enhance naltrexone treatment of opioid dependence: 

Efficacy of contingency management and significant 

other involvement. Archives of General Psychiatry 58(8):755–

761, 2001.

Cornish, J.W., et al. Naltrexone pharmacotherapy for 

opioid dependent federal probationers. Journal of Substance 

Abuse Treatment 14(6):529–534, 1997.

Greenstein, R.A.; Arndt, I.C.; McLellan, A.T.; and 

O’Brien, C.P. Naltrexone: A clinical perspective. Journal 

of Clinical Psychiatry 45(9, Part 2):25–28, 1984.

Preston, K.L.; Silverman, K.; Umbricht, A.; 

DeJesus, A.; Montoya, I.D.; and Schuster, C.R. 

Improvement in naltrexone treatment compliance with 

contingency management. Drug and Alcohol Dependence

54(2):127–135, 1999.

Resnick, R.B., and Washton, A.M. Clinical outcome with 

naltrexone: Predictor variables and followup status in 

detoxified heroin addicts. Annals of the New York Academy 

of Sciences 311:241–246, 1978.
42

Tobacco Addiction

Nicotine Replacement Therapy (NRT)

A variety of formulations of nicotine replacement 

therapies now exist, including the transdermal nicotine 

patch, nicotine spray, nicotine gum, and nicotine lozenges. 

Because nicotine is the main addictive ingredient in 

tobacco, the rationale for NRT is that stable low levels 

of nicotine will prevent withdrawal symptoms—which 

often drive continued tobacco use—and help keep people 

motivated to quit.

Bupropion (Zyban®)

Bupropion was originally marketed as an antidepressant 

(Wellbutrin®). It has mild stimulant effects through 

blockade of the reuptake of catecholamines, especially 

norepinephrine and dopamine. A serendipitous 

observation among depressed patients was the 

medication’s efficacy in suppressing tobacco craving, 

promoting cessation without concomitant weight gain. 

Although bupropion’s exact mechanisms of action in 

facilitating smoking cessation are unclear, it has FDA 

approval as a smoking cessation treatment.

Varenicline (Chantix®)

Varenicline is the most recently FDA-approved medication 

for smoking cessation. It acts on a subset of nicotinic 

receptors (alpha-4 beta-2) thought to be involved in 

the rewarding effects of nicotine. Varenicline acts as a 

partial agonist/antagonist at these receptors—this means 

that it mildly stimulates the nicotine receptor, but not 

sufficiently to allow the release of dopamine, which is 

important for the rewarding effects of nicotine. As an 

antagonist, varenicline also blocks the ability of nicotine to 

activate dopamine, interfering with the reinforcing effects 

of smoking, thereby reducing cravings and supporting 

abstinence from smoking.
43

Combined With Behavioral Treatment

Each of the above pharmacotherapies is recommended for 

use in combination with behavioral interventions, including 

group and individual therapies, as well as telephone 

quitlines. Through behavioral skills training, patients 

learn to avoid high-risk situations for smoking relapse 

and to plan strategies to cope with such situations when 

necessary. Coping techniques include cigarette refusal skills, 

assertiveness, and time management skills that patients 

practice in treatment, social, and work settings. Combined 

treatment is urged because behavioral and pharmacological 

treatments are thought to operate by different yet 

complementary mechanisms that can have additive effects. 

By dampening craving intensity, medications can give 

patients a leg up on enacting new strategies and skills.

Further Reading:

Alterman, A.I.; Gariti, P.; and Mulvaney, F.

Short- and long-term smoking cessation for three 

levels of intensity of behavioral treatment. Psychology 

of Addictive Behaviors 15:261–264, 2001.

Cinciripini, P.M.; Cinciripini, L.G.; Wallfisch, A.; Haque, 

W.; and Van Vunakis, H. Behavior therapy and the 

transdermal nicotine patch: Effects on cessation outcome, 

affect, and coping. Journal of Consulting and Clinical 

Psychology 64:314–323, 1996.

Hughes, J.R. Combined psychological and nicotine 

gum treatment for smoking: A critical review. Journal of 

Substance Abuse 3:337–350, 1991.

Jorenby, D.E., et al. Efficacy of varenicline, an α4β2 

nicotinic acetylcholine receptor partial agonist, vs placebo 

or sustained-release bupropion for smoking cessation: 

A randomized controlled trial. The Journal of the American 

Medical Association 296(1):56–63, 2006.

Stitzer, M. Combined behavioral and pharmacological 

treatments for smoking cessation. Nicotine & Tobacco 

Research 1:S181–S187, 1999.
44

Alcohol Addiction

Naltrexone

Naltrexone blocks opioid receptors that are involved in 

the rewarding effects of drinking and the craving for 

alcohol. It reduces relapse to heavy drinking, defined as 

four or more drinks per day for women and five or more 

for men. Naltrexone cuts relapse risk during the first 3 

months by about 36 percent but is less effective in helping 

patients maintain abstinence.

Acamprosate

Acamprosate (Campral®) acts on the gamma-aminobutyric 

acid (GABA) and glutamate neurotransmitter systems and 

is thought to reduce symptoms of protracted withdrawal, 

such as insomnia, anxiety, restlessness, and dysphoria. 

Acamprosate has been shown to help dependent drinkers 

maintain abstinence for several weeks to months, and it 

may be more effective in patients with severe dependence. 

Disulfiram

Disulfiram (Antabuse®) interferes with degradation of 

alcohol, resulting in the accumulation of acetaldehyde, 

which, in turn, produces a very unpleasant reaction 

that includes flushing, nausea, and palpitations if the 

patient drinks alcohol. The utility and effectiveness of 

disulfiram are considered limited because compliance 

is generally poor. However, among patients who are 

highly motivated, disulfiram can be effective, and some 

patients use it episodically for high-risk situations, such as 

social occasions where alcohol is present. It can also be 

administered in a monitored fashion, such as in a clinic or 

by a spouse, improving its efficacy.

Topiramate

Topiramate is thought to work by increasing inhibitory 

(GABA) neurotransmission and reducing stimulatory 
45

(glutamate) neurotransmission. Its precise mechanism 

of action in treating alcohol addiction is not known, 

and it has not yet received FDA approval. Topiramate 

has been shown in two randomized, controlled trials 

to significantly improve multiple drinking outcomes, 

compared with a placebo. Over the course of a 14-week 

trial, topiramate significantly increased the proportion 

of patients with 28 consecutive days of abstinence or 

non-heavy drinking. In both studies, the differences 

between topiramate and placebo groups were still 

diverging at the end of the trial, suggesting that the 

maximum effect may not have yet been reached. 

Importantly, efficacy was established in volunteers 

who were drinking upon starting the medication.

Combined With Behavioral Treatment

While a number of behavioral treatments have been 

shown to be effective in the treatment of alcohol 

addiction, it does not appear that an additive effect exists 

between behavioral treatments and pharmacotherapy. 

Studies have shown that getting help is one of the most 

important factors in treating alcohol addiction, compared 

to getting a particular type of treatment.

Further Reading:

Anton, R.F.; O’Malley, S.S.; Ciraulo, D.A.; et al., 

for the COMBINE Study Research Group. 

Combined pharmacotherapies and behavioral 

interventions for alcohol dependence: The 

COMBINE study: A randomized controlled 

trial. JAMA 295(17):2003–2017, 2006.

National Institute on Alcohol Abuse and Alcoholism. 

Helping Patients Who Drink Too Much: A Clinician’s Guide, 

Updated 2005 Edition. Bethesda, MD: NIAAA, updated 

2005. Available at http://www.niaaa.nih.gov/Publications/

EducationTrainingMaterials/guide.htm.
46

Behavioral Therapies

Behavioral treatments help engage people in drug 

abuse treatment, provide incentives for them to 

remain abstinent, modify their attitudes and behaviors 

related to drug abuse, and increase their life skills to 

handle stressful circumstances and environmental 

cues that may trigger intense craving for drugs and 

prompt another cycle of compulsive abuse. Below 

are a number of behavioral therapies shown to be 

effective in addressing substance abuse (effectiveness 

with particular drugs is denoted in parentheses).

Cognitive-Behavioral Therapy 

(Alcohol, Marijuana, Cocaine, 

Methamphetamine, Nicotine)

Cognitive-behavioral therapy was developed as a 

method to prevent relapse when treating problem 

drinking, and later was adapted for cocaine-addicted 

individuals. Cognitive-behavioral strategies are based 

on the theory that learning processes play a critical role 

in the development of maladaptive behavioral patterns. 

Individuals learn to identify and correct problematic 

behaviors by applying a range of different skills that can 

be used to stop drug abuse and to address a range of 

other problems that often co-occur with it.

Cognitive-behavioral therapy generally consists of a 

collection of strategies intended to enhance self-control. 

Specific techniques include exploring the positive and 

negative consequences of continued use, self-monitoring 

to recognize drug cravings early on and to identify highrisk situations for use, and developing strategies for coping 

with and avoiding high-risk situations and the desire to 

use. A central element of this treatment is anticipating 

likely problems and helping patients develop effective 

coping strategies.
47

Research indicates that the skills individuals learn 

through cognitive-behavioral approaches remain after 

the completion of treatment. In several studies, most 

people receiving a cognitive-behavioral approach 

maintained the gains they made in treatment throughout 

the following year.

Current research focuses on how to produce even more 

powerful effects by combining cognitive-behavioral 

therapy with medications for drug abuse and with other 

types of behavioral therapies. Researchers are also 

evaluating how best to train treatment providers to deliver 

cognitive-behavioral therapy.

Further Reading:

Carroll, K., et al. Efficacy of disulfiram and cognitive 

behavior therapy in cocaine-dependent outpatients: A 

randomized placebo-controlled trial. Archives of General 

Psychiatry 61(3):264–272, 2004.

Carroll, K.; Rounsaville, B.; and Keller, D. Relapse 

prevention strategies for the treatment of cocaine abuse. 

American Journal of Drug and Alcohol Abuse 17(3):249–265, 

1991. 

Carroll, K.; Rounsaville, B.; Nich, C.; Gordon, L.; Wirtz, 

P.; and Gawin, F. One-year follow-up of psychotherapy 

and pharmacotherapy for cocaine dependence: Delayed 

emergence of psychotherapy effects. Archives of General 

Psychiatry 51(12):989–997, 1994.

Carroll, K.; Sholomskas, D.; Syracuse, G.; Ball, S.A.; 

Nuro, K.; and Fenton, L.R. We don’t train in vain: A 

dissemination trial of three strategies of training clinicians 

in cognitive-behavioral therapy. Journal of Consulting and 

Clinical Psychology 73(1):106–115, 2005.

Carroll, K.M., et al. The use of contingency management 

and motivational/skills-building therapy to treat young 

adults with marijuana dependence. Journal of Consulting 

and Clinical Psychology 74(5):955–966, 2006.
48

Community Reinforcement Approach 

Plus Vouchers (Alcohol, Cocaine)

Community Reinforcement Approach (CRA) Plus 

Vouchers is an intensive 24-week outpatient therapy 

for treatment of cocaine and alcohol addiction. The 

treatment goals are twofold:

• To maintain abstinence long enough for patients to 

learn new life skills to help sustain it

• To reduce alcohol consumption for patients whose 

drinking is associated with cocaine use

Patients attend one or two individual counseling sessions 

each week, where they focus on improving family 

relations, learning a variety of skills to minimize drug 

use, receiving vocational counseling, and developing new 

recreational activities and social networks. Those who 

also abuse alcohol receive clinic-monitored disulfiram 

(Antabuse) therapy. Patients submit urine samples two or 

three times each week and receive vouchers for cocainenegative samples. The value of the vouchers increases 

with consecutive clean samples. Patients may exchange 

vouchers for retail goods that are consistent with a 

cocaine-free lifestyle.

This approach facilitates patients’ engagement in 

treatment and systematically aids them in gaining 

substantial periods of cocaine abstinence. The approach 

has been tested in urban and rural areas and used 

successfully in outpatient treatment of opioid-addicted 

adults and with inner-city methadone maintenance 

patients with high rates of intravenous cocaine abuse.

Further Reading:

Higgins, S.T., et al. Community reinforcement therapy 

for cocaine-dependent outpatients. Archives of General 

Psychiatry 60(10):1043–1052, 2003.
49

Roozen, H.G.; Boulogne, J.J.; van Tulder, M.W.; van 

den Brink, W.; De Jong, C.A.J.; and Kerhof, J.F.M. A 

systemic review of the effectiveness of the community 

reinforcement approach in alcohol, cocaine and opioid 

addiction. Drug and Alcohol Dependence 74(1):1–13, 2004.

Silverman, K., et al. Sustained cocaine abstinence 

in methadone maintenance patients through 

voucher-based reinforcement therapy. Archives of 

General Psychiatry 53(5):409–415, 1996.

Smith, J.E.; Meyers, R.J.; and Delaney, H.D. 

The community reinforcement approach with 

homeless alcohol-dependent individuals. Journal of 

Consulting and Clinical Psychology 66(3):541–548, 1998.

Stahler, G.J., et al. Development and initial demonstration 

of a community-based intervention for homeless, cocaineusing, African-American women. Journal of Substance Abuse 

Treatment 28(2):171–179, 2005.

Contingency Management Interventions/

Motivational Incentives 

(Alcohol, Stimulants, Opioids, 

Marijuana, Nicotine)

Research has demonstrated the effectiveness of 

treatment approaches using contingency management 

principles, which involve giving patients in drug 

treatment the chance to earn low-cost incentives 

in exchange for drug-free urine samples. These 

incentives include prizes given immediately or 

vouchers exchangeable for food items, movie passes, 

and other personal goods. Studies conducted in both 

methadone programs and psychosocial counseling 

treatment programs demonstrate that incentive-based 

interventions are highly effective in increasing treatment 

retention and promoting abstinence from drugs. 
50

Some concerns have been raised that a prize-based 

contingency management intervention could promote 

gambling—as it contains an element of chance—and 

that pathological gambling and substance use disorders 

can be comorbid. However, studies have shown no 

differences in gambling over time between those assigned 

to the contingency management conditions and those 

in the usual care groups, indicating that this prize-based 

contingency management procedure did not promote 

gambling behavior.

Further Reading:

Budney, A.J.; Moore, B.A.; Rocha, H.L.; and Higgins, S.T. 

Clinical trial of abstinence-based vouchers and cognitivebehavioral therapy for cannabis dependence. Journal of 

Consulting and Clinical Psychology 74(2):307–316, 2006.

Budney, A.J.; Roffman, R.; Stephens, R.S.; and Walker, D. 

Marijuana dependence and its treatment. Addiction Science 

& Clinical Practice 4(1):4–16, 2007.

Elkashef, A.; Vocci, F.; Huestis, M.; Haney, M.; Budney, A.; 

Gruber, A.; and el-Guebaly, N. Marijuana neurobiology 

and treatment. Substance Abuse 29(3):17–29, 2008.

Peirce, J.M., et al. Effects of lower-cost incentives 

on stimulant abstinence in methadone maintenance 

treatment: A National Drug Abuse Treatment Clinical 

Trials Network study. Archives of General Psychiatry

63(2):201–208, 2006.

Petry, N.M., et al. Effect of prize-based incentives on 

outcomes in stimulant abusers in outpatient psychosocial 

treatment programs: A National Drug Abuse Treatment 

Clinical Trials Network study. Archives of General Psychiatry

62(10):1148–1156, 2005.

Petry, N.M., et al. Prize-based contingency management 

does not increase gambling. Drug and Alcohol Dependence

83(3):269–273, 2006.
51

Prendergast, M.; Podus, D.; Finney, J.; Greenwell, L.; 

and Roll, J. Contingency management for treatment 

of substance use disorders: A meta-analysis. Addiction

101(11):1546–1560, 2006.

Roll, J.M., et al. Contingency management for the 

treatment of methamphetamine use disorders. The 

American Journal of Psychiatry 163(11):1993–1999, 2006.

Motivational Enhancement Therapy 

(Alcohol, Marijuana, Nicotine)

Motivational Enhancement Therapy (MET) is a patientcentered counseling approach for initiating behavior 

change by helping individuals resolve ambivalence about 

engaging in treatment and stopping drug use. This 

approach employs strategies to evoke rapid and internally 

motivated change, rather than guiding people stepwise 

through the recovery process. This therapy consists of an 

initial assessment battery session, followed by two to four 

individual treatment sessions with a therapist. In the first 

treatment session, the therapist provides feedback to the 

initial assessment battery, stimulating discussion about 

personal substance use and eliciting self-motivational 

statements. Motivational interviewing principles are used 

to strengthen motivation and build a plan for change. 

Coping strategies for high-risk situations are suggested 

and discussed with the patient. In subsequent sessions, the 

therapist monitors change, reviews cessation strategies 

being used, and continues to encourage commitment to 

change or sustained abstinence. Patients sometimes are 

encouraged to bring a significant other to sessions.

Research on MET suggests that its effects depend on the 

type of drug used by participants and on the goal of the 

intervention. This approach has been used successfully 

with alcoholics to improve both treatment engagement 

and treatment outcomes (e.g., reductions in problem 

drinking). MET has also been used successfully with 

adult marijuana-dependent individuals in combination 
52

with cognitive-behavioral therapy, comprising a more 

comprehensive treatment approach. The results of MET 

are mixed for participants abusing other drugs (e.g., heroin, 

cocaine, nicotine, etc.) and for adolescents who tend to 

use multiple drugs. In general, MET seems to be more 

effective for engaging drug abusers in treatment than for 

producing changes in drug use.

Further Reading:

Baker, A., et al. Evaluation of a motivational interview 

for substance use with psychiatric in-patient services. 

Addiction 97(10):1329–1337, 2002.

Haug, N.A.; Svikis, D.S.; and Diclemente, C. 

Motivational enhancement therapy for nicotine 

dependence in methadone-maintained pregnant women. 

Psychology of Addictive Behaviors 18(3):289–292, 2004.

Marijuana Treatment Project Research Group. Brief 

treatments for cannabis dependence: Findings from a 

randomized multisite trial. Journal of Consulting and 

Clinical Psychology 72(3):455–466, 2004.

Miller, W.R.; Yahne, C.E.; and Tonigan, J.S. 

Motivational interviewing in drug abuse services: 

A randomized trial. Journal of Consulting and Clinical 

Psychology 71(4):754–763, 2003.

Stotts, A.L.; Diclemente, C.C.; and Dolan-Mullen, P. 

One-to-one: A motivational intervention for resistant 

pregnant smokers. Addictive Behaviors 27(2):275–292, 2002.

The Matrix Model (Stimulants)

The Matrix Model provides a framework for engaging 

stimulant (e.g., methamphetamine and cocaine) abusers in 

treatment and helping them achieve abstinence. Patients 

learn about issues critical to addiction and relapse, receive 

direction and support from a trained therapist, become 

familiar with self-help programs, and are monitored for 

drug use through urine testing.
53

The therapist functions simultaneously as teacher and 

coach, fostering a positive, encouraging relationship 

with the patient and using that relationship to reinforce 

positive behavior change. The interaction between the 

therapist and the patient is authentic and direct but not 

confrontational or parental. Therapists are trained to 

conduct treatment sessions in a way that promotes the 

patient’s self-esteem, dignity, and self-worth. A positive 

relationship between patient and therapist is critical to 

patient retention.

Treatment materials draw heavily on other tested 

treatment approaches and, thus, include elements of 

relapse prevention, family and group therapies, drug 

education, and self-help participation. Detailed treatment 

manuals contain worksheets for individual sessions; 

other components include family education groups, 

early recovery skills groups, relapse prevention groups, 

combined sessions, urine tests, 12-step programs, relapse 

analysis, and social support groups.

A number of studies have demonstrated that participants 

treated using the Matrix Model show statistically 

significant reductions in drug and alcohol use, 

improvements in psychological indicators, and reduced 

risky sexual behaviors associated with HIV transmission.

Further Reading:

Huber, A.; Ling, W.; Shoptaw, S.; Gulati, V.; Brethen, P.; 

and Rawson, R. Integrating treatments for methamphetamine abuse: A psychosocial perspective. Journal of 

Addictive Diseases 16(4):41–50, 1997.

Rawson, R., et al. An intensive outpatient approach for 

cocaine abuse: The Matrix model. Journal of Substance 

Abuse Treatment 12(2):117–127, 1995.

Rawson, R.A., et al. A comparison of contingency 

management and cognitive-behavioral approaches 

during methadone maintenance treatment for 

cocaine dependence. Archives of General Psychiatry 

59(9):817–824, 2002.
54

12-Step Facilitation Therapy 

(Alcohol, Stimulants, Opiates)

Twelve-step facilitation therapy is an active engagement 

strategy designed to increase the likelihood of a substance 

abuser becoming affiliated with and actively involved in 

12-step self-help groups and, thus, promote abstinence. 

Three key aspects predominate: acceptance, which includes 

the realization that drug addiction is a chronic, progressive 

disease over which one has no control, that life has 

become unmanageable because of drugs, that willpower 

alone is insufficient to overcome the problem, and that 

abstinence is the only alternative; surrender, which involves 

giving oneself over to a higher power, accepting the 

fellowship and support structure of other recovering 

addicted individuals, and following the recovery activities 

laid out by the 12-step program; and active involvement

in 12-step meetings and related activities. While the 

efficacy of 12‐step programs (and 12‐step facilitation) in 

treating alcohol dependence has been established, the 

research on other abused drugs is more preliminary 

but promising for helping drug abusers sustain recovery. 

NIDA has recognized the need for more research in this 

area and is currently funding a community-based study 

to examine the impact of 12-step facilitation therapy for 

methamphetamine and cocaine abusers.

Further Reading:

Carroll, K.M.; Nich, C.; Ball, S.A.; McCance, E.; 

Frankforter, T.L.; and Rounsaville, B.J. One-year 

follow-up of disulfiram and psychotherapy for cocainealcohol users: Sustained effects of treatment. Addiction

95(9):1335–1349, 2000.

Donovan D.M., and Wells E.A. “Tweaking 12‐step”: 

The potential role of 12-Step self-help group 

involvement in methamphetamine recovery. Addiction

102(Suppl. 1):121–129, 2007.
55

Project MATCH Research Group. Matching alcoholism 

treatments to client heterogeneity: Project MATCH 

posttreatment drinking outcomes. Journal of Studies on 

Alcohol 58(1)7–29, 1997.

Behavioral Couples Therapy

Behavioral Couples Therapy (BCT) is a therapy for 

drug abusers with partners. BCT uses a sobriety/

abstinence contract and behavioral principles to reinforce 

abstinence from drugs and alcohol. It has been studied 

as an add-on to individual and group therapy and 

typically involves 12 weekly couple sessions, lasting 

approximately 60 minutes each. Many studies support 

BCT’s efficacy with alcoholic men and their spouses; 

four studies support its efficacy with drug-abusing men 

and women and their significant others. BCT also has 

been shown to produce higher treatment attendance, 

naltrexone adherence, and rates of abstinence than 

individual treatment, along with fewer drug-related, 

legal, and family problems at 1-year followup.

Recent research has focused on making BCT more 

community-friendly by adapting the therapy for delivery 

in fewer sessions and in a group format. Research is also 

being done to demonstrate cost-effectiveness and to test 

therapy effectiveness according to therapist training.

Further Reading:

Fals-Stewart, W.; Klosterman, K.; Yates, B.T.; O’Farrell, 

T.J.; and Birchler, G.R. Brief relationship therapy for 

alcoholism: A randomized clinical trial examining clinical 

efficacy and cost-effectiveness. Psychology of Addictive 

Behaviors 19(4):363–371, 2005.

Fals-Stewart, W.; O’Farrell, T.J.; and Birchler, G.R. 

Behavioral couples therapy for male methadone 

maintenance patients: Effects on drug-using behavior 

and relationship adjustment. Behavior Therapy

32(2):391–411, 2001.
56

Kelley, M. L., and Fals-Stewart, W. Couples- versus 

individual-based therapy for alcohol and drug abuse: 

Effects on children’s psychosocial functioning. Journal of 

Consulting and Clinical Psychology 70(2):417–427, 2002.

Klostermann, K.; Fals-Stewart, W.; and Yates, B.T. 

Behavioral couples therapy for substance abuse: A cost 

analysis. Alcoholism: Clinical Experimental Research

28(Suppl.):164A, 2004.

Winters, J.; Fals-Stewart, W.; O’Farrell, T.J.; Birchler, G.R; 

and Kelley, M.L. Behavioral couples therapy for female 

substance-abusing patients: Effects on substance use and 

relationship adjustment. Journal of Consulting and Clinical 

Psychology 70(2):344–355, 2002.

Behavioral Treatments for Adolescents

Drug-abusing and addicted adolescents have unique 

treatment needs. Research has shown that treatments 

designed for and tested in adult populations often need 

to be modified to be effective in adolescents. Family 

involvement is a particularly important component for 

interventions targeting youth. Below are examples of 

behavioral interventions that employ these principles and 

have shown efficacy for treating addiction in youth.

Multisystemic Therapy

Multisystemic Therapy (MST) addresses the factors 

associated with serious antisocial behavior in children and 

adolescents who abuse alcohol and other drugs. These 

factors include characteristics of the child or adolescent 

(e.g., favorable attitudes toward drug use), the family (poor 

discipline, family conflict, parental drug abuse), peers 

(positive attitudes toward drug use), school (dropout, poor 

performance), and neighborhood (criminal subculture). 

By participating in intensive treatment in natural 

environments (homes, schools, and neighborhood settings), 
57

most youths and families complete a full course of 

treatment. MST significantly reduces adolescent drug use 

during treatment and for at least 6 months after treatment. 

Fewer incarcerations and out-of-home juvenile placements 

offset the cost of providing this intensive service and 

maintaining the clinicians’ low caseloads.

Further Reading:

Henggeler, S.W.; Clingempeel, W.G.; Brondino, M.J.; and 

Pickrel, S.G. Four-year follow-up of multisystemic therapy 

with substance-abusing and substance-dependent juvenile 

offenders. Journal of the American Academy of Child and 

Adolescent Psychiatry 41(7):868–874, 2002.

Henggeler, S.W., et al. Home-based multisystemic 

therapy as an alternative to the hospitalization of 

youths in psychiatric crisis: Clinical outcomes. Journal 

of the American Academy of Child and Adolescent Psychiatry

38(11):1331–1339, 1999.

Henggeler, S.W.; Halliday-Boykins, C.A.; Cunningham, 

P.B.; Randall, J.; Shapiro, S.B.; and Chapman, J.E. 

Juvenile drug court: Enhancing outcomes by integrating 

evidence-based treatments. Journal of Consulting and Clinical 

Psychology 74(1):42–54, 2006.

Henggeler, S.W.; Pickrel, S.G.; Brondino, M.J.; and 

Crouch, J.L. Eliminating (almost) treatment dropout of 

substance-abusing or dependent delinquents through 

home-based multisystemic therapy. The American Journal of 

Psychiatry 153(3):427–428, 1996.

Huey, S.J.; Henggeler, S.W.; Brondino, M.J.; and 

Pickrel, S.G. Mechanisms of change in multisystemic 

therapy: Reducing delinquent behavior through therapist 

adherence and improved family functioning. Journal of 

Consulting and Clinical Psychology 68(3):451–467, 2000.
58

Multidimensional Family Therapy for Adolescents 

Multidimensional Family Therapy (MDFT) for adolescents 

is an outpatient family-based alcohol and other drug abuse 

treatment for teenagers. MDFT views adolescent drug 

use in terms of a network of influences (individual, family, 

peer, community) and suggests that reducing unwanted 

behavior and increasing desirable behavior occur in 

multiple ways in different settings. Treatment includes 

individual and family sessions held in the clinic, in the 

home, or with family members at the family court, school, 

or other community locations.

During individual sessions, the therapist and 

adolescent work on important developmental tasks, 

such as developing decisionmaking, negotiation, and 

problemsolving skills. Teenagers acquire vocational skills 

and skills in communicating their thoughts and feelings 

to deal better with life stressors. Parallel sessions are held 

with family members. Parents examine their particular 

parenting styles, learning to distinguish influence from 

control and to have a positive and developmentally 

appropriate influence on their children.

Further Reading:

Dennis, M., et al. The Cannabis Youth Treatment (CYT) 

Study: Main findings from two randomized clinical trials. 

Journal of Substance Abuse Treatment 27(3):197–213, 2004.

Liddle, H.A.; Dakof, G.A.; Parker, K.; Diamond, 

G.S.; Barrett, K;, and Tejeda, M. Multidimensional 

family therapy for adolescent drug abuse: Results of a 

randomized clinical trial. The American Journal of Drug and 

Alcohol Abuse 27(4):651–688, 2001.

Liddle, H.A., and Hogue, A. Multidimensional family 

therapy for adolescent substance abuse. In E.F. Wagner 

and H.B. Waldron (eds.), Innovations in Adolescent Substance 

Abuse Interventions. London: Pergamon/Elsevier Science, 

pp. 227–261, 2001.
59

Liddle, H.A.; Rowe, C.L.; Dakof, G.A.; Ungaro, R.A.; 

and Henderson, C.E. Early intervention for adolescent 

substance abuse: Pretreatment to posttreatment outcomes 

of a randomized clinical trial comparing multidimensional 

family therapy and peer group treatment. Journal of 

Psychoactive Drugs 36(1):49–63, 2004.

Schmidt, S.E.; Liddle, H.A.; and Dakof, G.A. Effects 

of multidimensional family therapy: Relationship of 

changes in parenting practices to symptom reduction in 

adolescent substance abuse. Journal of Family Psychology

10(1):1–16, 1996.

Brief Strategic Family Therapy

Brief Strategic Family Therapy (BSFT) targets family 

interactions that are thought to maintain or exacerbate 

adolescent drug abuse and other co-occurring problem 

behaviors. Such problem behaviors include conduct 

problems at home and at school, oppositional behavior, 

delinquency, associating with antisocial peers, aggressive 

and violent behavior, and risky sexual behavior. BSFT 

is based on a family systems approach to treatment, 

where family members’ behaviors are assumed to be 

interdependent such that the symptoms of any one 

member (the drug-abusing adolescent, for example) are 

indicative, at least in part, of what else is going on in 

the family system. The role of the BSFT counselor is 

to identify the patterns of family interaction that are 

associated with the adolescent’s behavior problems and 

to assist in changing those problem-maintaining family 

patterns. BSFT is meant to be a flexible approach that can 

be adapted to a broad range of family situations in various 

settings (mental health clinics, drug abuse treatment 

programs, other social service settings, and families’ 

homes) and in various treatment modalities (as a primary 

outpatient intervention, in combination with residential or 

day treatment, and as an aftercare/continuing-care service 

to residential treatment).
60

Further Reading:

Coatsworth, J.D.; Santisteban, D.A.; McBride, C.K.; and 

Szapocznik, J. Brief Strategic Family Therapy versus 

community control: Engagement, retention, and an 

exploration of the moderating role of adolescent severity. 

Family Process 40(3):313–332, 2001.

Santisteban, D.A.; Coatsworth, J.D.; Perez-Vidal, A.; 

Mitrani, V.; Jean-Gilles, M.; and Szapocznik, J. Brief 

Structural/Strategic Family Therapy with AfricanAmerican and Hispanic high-risk youth. Journal of 

Community Psychology 25(5):453–471, 1997.

Santisteban, D.A.; Suarez-Morales, L.; Robbins, M.S.; 

and Szapocznik, J. Brief strategic family therapy: Lessons 

learned in efficacy research and challenges to blending 

research and practice. Family Process 45(2):259–271, 2006.

Santisteban, D.A.; Szapocznik, J.; Perez-Vidal, A.; 

Kurtines, W.M.; Murray, E.J.; and Laperriere, A. Efficacy 

of intervention for engaging youth and families into 

treatment and some variables that may contribute to 

differential effectiveness. Journal of Family Psychology

10(1):35–44, 1996.

Szapocznik, J., et al. Engaging adolescent drug abusers 

and their families in treatment: A strategic structural 

systems approach. Journal of Consulting and Clinical 

Psychology 56(4):552–557, 1988.
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Resources 63

General inquiries

Inquiries about NIDA’s behavioral treatment research 

activities should be directed to the Division of Clinical 

Neuroscience and Behavioral Research at 301-443-

0107. For questions regarding NIDA’s medications 

development program, please contact the Division of 

Pharmacotherapies and Medical Consequences of Drug 

Abuse at 301-443-6173. For questions regarding treatment 

organization, management, financing, effectiveness, and 

cost-effectiveness research, please contact the Division 

of Epidemiology, Services and Prevention Research at 

301-443-4060; for questions regarding NIDA-supported 

clinical trials, please call the National Drug Abuse 

Treatment Clinical Trials Network at 301-443-6697; and 

for questions regarding NIDA’s HIV/AIDS research, 

please contact the AIDS Research Program at 301-

443-1470. Additional general information is available 

at www.drugabuse.gov or by calling 301-443-1124.

National Institute on Alcohol 

Abuse and Alcoholism (NIAAA)

NIAAA provides leadership in the national effort to 

reduce alcohol-related problems by conducting and 

supporting research in a wide range of scientific areas, 

including genetics, neuroscience, epidemiology, health 

risks and benefits of alcohol consumption, prevention, 

and treatment; coordinating and collaborating with 

other research institutes and Federal programs on 

alcohol-related issues; collaborating with international, 

national, State, and local institutions, organizations, 

agencies, and programs engaged in alcohol-related work; 

and translating and disseminating research findings 

to health care providers, researchers, policymakers, 

and the public. Additional information is available 

at www.niaaa.nih.gov or by calling 301-443-3860.

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64

National Institute of Mental Health 

(NIMH)

The mission of NIMH is to transform the understanding 

and treatment of mental illnesses through basic and 

clinical research, paving the way for prevention, recovery, 

and cure. In support of this mission, NIMH generates 

research and promotes research training to fulfill the 

following four objectives: promote discovery in the brain 

and behavioral sciences to fuel research on the causes 

of mental disorders; chart mental illness trajectories to 

determine when, where, and how to intervene; develop 

new and better interventions that incorporate the diverse 

needs and circumstances of people with mental illnesses; 

and strengthen the public health impact of NIMHsupported research. Additional information is available at 

www.nimh.nih.gov or by calling 301-443-4513.

Center for Substance Abuse 

Treatment (CSAT)

CSAT, a part of the Substance Abuse and Mental Health 

Services Administration (SAMHSA), is responsible for 

supporting treatment services through a block grant 

program, as well as disseminating findings to the field 

and promoting their adoption. CSAT also operates the 

24-hour National Treatment Referral Hotline (1-800-662-

HELP), which offers information and referral services to 

people seeking treatment programs and other assistance. 

CSAT publications are available through the National 

Clearinghouse on Alcohol and Drug Information (1-800-

729-6686). Additional information about CSAT can be 

found on SAMHSA’s Web site at www.csat.samhsa.gov.
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Selected NIDA Educational Resources 

on Drug Addiction Treatment

The following are available from the NIDA DrugPubs

Research Dissemination Center, the National Technical 

Information Service (NTIS), or the Government Printing 

Office (GPO). To order, refer to the DrugPubs (877-NIDANIH [643-2644]), NTIS (1-800-553-6847), or GPO (202-

512-1800) number provided with the resource description.

Manuals and Clinical Reports

Principles of Drug Abuse Treatment for Criminal 

Justice Populations: A Research-Based Guide

(Revised 2007). Provides 13 essential treatment principles 

and includes resource information and answers to 

frequently asked questions. Publication #NIH 07-5316. 

Available online at www.nida.nih.gov/PODAT_CJ.

Measuring and Improving Cost, Cost-Effectiveness, 

and Cost-Benefit for Substance Abuse Treatment 

Programs (1999). Offers tools for substance abuse 

treatment program managers to calculate the costs of their 

programs and investigate the relationship between those 

costs and treatment outcomes. Available online at

www.nida.nih.gov/IMPCOST/IMPCOSTIndex.html.

A Cognitive-Behavioral Approach: Treating 

Cocaine Addiction (1998). This is the first in NIDA’s 

“Therapy Manuals for Drug Addiction” series. Describes 

cognitive-behavioral therapy, a short-term, focused 

approach to helping cocaine-addicted individuals become 

abstinent from cocaine and other drugs. Available online 

at www.nida.nih.gov/TXManuals/CBT/CBT1.html.
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A Community Reinforcement Plus Vouchers 

Approach: Treating Cocaine Addiction (1998). This 

is the second in NIDA’s “Therapy Manuals for Drug 

Addiction” series. This treatment integrates a community 

reinforcement approach with an incentive program 

that uses vouchers. Available online at www.nida.nih.gov/

TXManuals/CRA/CRA1.html.

An Individual Drug Counseling Approach to 

Treat Cocaine Addiction: The Collaborative 

Cocaine Treatment Study Model (1999). This is the 

third in NIDA’s “Therapy Manuals for Drug Addiction” 

series. Describes specific behavioral/cognitive models 

that can be implemented in a wide range of drug abuse 

treatment settings. Available online at www.nida.nih.gov/

TXManuals/IDCA/IDCA1.html.

Addiction Severity Index (ASI). Provides a structured 

clinical interview designed to collect information 

about substance use and functioning in life areas from 

adult clients seeking drug abuse treatment. For more 

information on using the ASI and to obtain copies of the 

most recent edition, please visit www.tresearch.org/resources/

instruments.htm#top.
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Other Useful Publications

Drugs, Brains, and Behavior: The Science of 

Addiction (Reprinted 2008). This publication provides an 

overview of the science behind the disease of addiction. 

Publication #NIH 08–5605. Available online at www.nida.

nih.gov/scienceofaddiction.

A Collection of NIDA Notes Articles That 

Address Drug Abuse Treatment (Reprinted 2008). 

This collection of NIDA Notes articles showcases NIDA 

treatment-related research. Publication #NN0026. Available 

online at www.nida.nih.gov/NIDA_Notes/NN0026.html.

NIDA InfoFacts: Treatment Approaches for Drug 

Addiction (Revised 2008). This is a fact sheet covering 

research findings on effective treatment approaches for 

drug abuse and addiction. Available online at www.nida.nih.

gov/infofacts/treatmeth.html.

Alcohol Alert (published by NIAAA). This is a 

quarterly bulletin that disseminates important research 

findings on alcohol abuse and alcoholism. Available online 

at www.niaaa.nih.gov/Publications/AlcoholAlerts.

NIAAA Clinical Guidelines/Related Resources.

This Web site has information to help clinicians in the 

screening, diagnosis, and treatment of patients who 

drink too much. Available online at www.niaaa.nih.gov/

Publications/EducationTrainingMaterials/guide.htm.

Research Report Series: Therapeutic Community 

(2002). This report provides information on the role 

of residential drug-free settings and their role in the 

treatment process. Publication #PHD947. Available online 

at www.nida.nih.gov/ResearchReports/Therapeutic/default.html.

The NIDA Clinical Toolbox: Science-Based 

Materials for Drug Abuse Treatment Providers 

(2000). This Web site contains science-based materials 

for drug abuse treatment providers. Links are provided to 

treatment manuals, Research Reports, and more. Available 

online at www.nida.nih.gov/TB/Clinical/ClinicalToolbox.html. 
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Initiatives Designed to Move 

Treatment Research into Practice

Clinical Trials Network

Assessing the real-world effectiveness of evidence-based 

treatments is a crucial step in bringing research to practice. 

Established in 1999, NIDA’s National Drug Abuse 

Treatment Clinical Trials Network (CTN) uses community 

settings with diverse patient populations and conditions 

to adjust and test protocols to meet the practical needs 

of addiction treatment. Since its inception, the CTN 

has tested pharmacological and behavioral interventions 

for drug abuse and addiction, along with common 

co-occurring conditions (e.g. HIV and PTSD) among 

various target populations, including adolescent drug 

abusers, pregnant drug-abusing women, and Spanishspeaking patients. The CTN has also tested prevention 

strategies in drug-abusing groups at high risk for hepatitis 

C (HCV) and HIV and has become a key element of 

NIDA’s multipronged approach to move promising 

science-based drug addiction treatments rapidly into 

community settings. For more information on the CTN, 

please visit www.drugabuse.gov/CTN/Index.htm. 

Criminal Justice–Drug Abuse

Treatment Studies

NIDA is taking an approach similar to the CTN to 

enhance treatment for drug-addicted individuals 

involved with the criminal justice system through the 

CJ-DATS (Criminal Justice–Drug Abuse Treatment 

Studies). Whereas NIDA’s CTN has as its overriding 

mission the improvement of the quality of drug abuse 

treatment by moving innovative approaches into 

the larger community, research supported through 
69

CJ-DATS is designed to effect change by bringing new 

treatment models into the criminal justice system and 

thereby improve outcomes for offenders with substance 

use disorders. It seeks to achieve better integration of 

drug abuse treatment with other public health and 

public safety forums and represents a collaboration 

among NIDA; the Substance Abuse and Mental Health 

Services Administration (SAMHSA); the Centers for 

Disease Control and Prevention (CDC); Department of 

Justice agencies; and a host of drug treatment, criminal 

justice, and health and social service professionals.

Blending Teams

Another way in which NIDA is seeking to actively move 

science into practice is through a joint venture with 

SAMHSA and its nationwide network of Addiction 

Technology Transfer Centers (ATTCs). This process 

involves the collaborative efforts of community treatment 

practitioners, SAMHSA trainers, and NIDA researchers, 

some of whom form “Blending Teams” to create 

products and devise strategic dissemination plans for 

them. Through the creation of products designed to foster 

adoption of new treatment strategies, Blending Teams 

are instrumental in getting the latest evidence-based tools 

and practices into the hands of treatment professionals. 

To date, a number of products have been completed. 

Topics have included increasing awareness of the value of 

buprenorphine therapy and enhancing healthcare workers’ 

proficiency in using tools such as the Addiction Severity 

Index (ASI), motivational interviewing, and motivational 

incentives. For more information on Blending products, 

please visit NIDA’s Web site at www.nida.nih.gov/blending.
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Other Federal Resources

NIDA DrugPubs Research Dissemination Center.

NIDA publications and treatment materials are available 

from this information source. Staff provide assistance 

in English and Spanish, and have TDD capability. 

Phone: 877-NIDA-NIH (877-643-2644); TTY/TDD:

240-645-0228; fax: 240-645-0227; e-mail:

drugpubs@nida.nih.gov; Web site: www.drugabuse.gov.

The National Registry of Evidence-Based 

Programs and Practices. This database of 

interventions for the prevention and treatment of mental 

and substance use disorders is maintained by SAMHSA 

and can be accessed at www.nrepp.samhsa.gov.

The National Clearinghouse for Alcohol 

and Drug Information (NCADI). Publications 

from other Federal agencies are available from this 

information source. Staff provide assistance in English 

and Spanish, and have TDD capability. Phone: 

800-729-6686; Web site: www.ncadi.samhsa.gov.

The National Institute of Justice (NIJ). As the 

research agency of the Department of Justice, NIJ 

supports research, evaluation, and demonstration 

programs relating to drug abuse in the context of crime 

and the criminal justice system. For information, including 

a wealth of publications, contact the National Criminal 

Justice Reference Service at 800-851-3420 or

301-519-5500; or visit www.ojp.usdoj.gov/nij.

Clinical Trials. For more information on federally 

and privately supported clinical trials please visit 

www.clinicaltrials.gov.
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NIH Publication No. 09–4180

Printed October 1999;

Reprinted July 2000, February 2008; Revised April 2009

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

National Institutes of Health