Surgeon General’s Principles for Effective Treatment of Substance Use Disorders

The entire Chapter 4 of today’s Surgeon General’s Report on Alcohol, Drugs, and Health is on treatment. Page 14 of the report states principles for effective treatment of addiction. Although these principles were released by the National Institute on Drug Abuse in 2012 for adults and 2014 for adolescents, with the Surgeon General’s endorsement, there should no longer be any debate about what evidence-based medicine for addiction treatment entails.

Principles of Effective Treatment for Adults

  1. Addiction is a complex but treatable disease that affects brain function and behavior.
  2. No single treatment is appropriate for everyone.
  3. Treatment needs to be readily available.
  4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
  5. Remaining in treatment for an adequate period of time is critical.
  6. Behavioral therapies—including individual, family, or group counseling– are the most commonly used forms of drug abuse treatment.
  7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
  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.
  9. Many drug-addicted individuals also have other mental disorders.
  10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
  11. Treatment does not need to be voluntary to be effective.
  12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
  13. Treatment programs should test patients for the presence of HIV/AIDS, Hepatitis B and C, tuberculosis, and other infectious diseases,provide risk-reduction counseling, and link patients to treatment if necessary.

Principles of Effective Treatment for Adolescents

  1. Adolescent substance use needs to be identified and addressed as soon as possible.
  2. Adolescents can benefit from a drug abuse intervention even if they are not addicted to a drug.
  3. Routine annual medical visits are an opportunity to ask adolescents about drug use.
  4. Legal interventions and sanctions or family pressure may play an important role in getting adolescents to enter, stay in, and complete treatment.
  5. Substance use disorder treatment should be tailored to the unique needs of the adolescent.
  6. Treatment should address the needs of the whole person, rather than just focusing on his or her drug use.
  7. Behavioral therapies are effective in addressing adolescent drug use.
  8. Families and the community are important aspects of treatment.
  9. Effectively treating substance use disorders in adolescents requires also identifying and treating any other mental health conditions they may have.
  10. Sensitive issues such as violence and child abuse or risk of suicide should be identified and addressed.
  11. It is important to monitor drug use during treatment.
  12. Staying in treatment for an adequate period of time and continuity of care afterward are important.
  13. Testing adolescents for sexually transmitted diseases like HIV, as well as Hepatitis B and C, is an important part of drug treatment.

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