Science-Based Views of Drug Addiction and Its Treatment

Leshner, Alan I.

doi:10.1001/jama.282.14.1314

Cited by 155 publications

(95 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…No pharmacotherapies for substance use disorders are sufficiently comprehensive in their effects to be a sole treatment because substance abusers frequently enter treatment with comorbid mental disorders and multiple functional impairments (Leshner, 1999;McLellan et al, 1993;O'Brien, 1997). Behavioral treatments may be needed to address these ancillary problems so that study subjects have a sufficient level of symptom control or stability to participate and/or hope to achieve benefit from the pharmacotherapy treatments being evaluated.…”

Section: Managing Problems Other Than Drug Usementioning

confidence: 99%

Choosing a behavioral therapy platform for pharmacotherapy of substance users

Carroll

Kosten

Rounsaville

2004

Drug and Alcohol Dependence

View full text Add to dashboard Cite

Behavioral therapy platforms have become virtual requirements in pharmacotherapy trials due to their utility in reducing noise variability, preventing differential medication adherence and protocol attrition, enhancing statistical power and addressing ethical issues in placebo-controlled trials. Selecting an appropriate behavioral platform for a particular trial requires study-specific tailoring, taking into account both the stage of development of the medication being evaluated, as well as the specific strengths and weaknesses of a broad array of available empirically supported behavioral therapies and the range of their possible targets (e.g., enhancing medication adherence, preventing attrition, addressing co-morbid problems, fostering abstinence, and targeting specific weaknesses of the pharmacologic agent). Choosing a suitable behavioral platform also requires consideration of the characteristics of the population to be treated, stage of scientific knowledge regarding the medication's effects, appropriate balance of internal and external validity, and consideration of potential ceiling effects. Available manualized behavioral treatments are reviewed, noting their strengths and limitations as behavioral therapy platforms for pharmacotherapy trials and as potential concomitant therapies in clinical practice.

show abstract

Section: Managing Problems Other Than Drug Usementioning

confidence: 99%

Choosing a behavioral therapy platform for pharmacotherapy of substance users

Carroll

Kosten

Rounsaville

2004

Drug and Alcohol Dependence

View full text Add to dashboard Cite

show abstract

“…31 Such attitudes act as barriers to effective and sustained treatment and recovery for patients. 39 A more detailed understanding of these factors is a precondition to success in efforts to bring about greater physician involvement 40 (and with that, broader public support) in the care of IDUs, including changes in legal and institutional policies, as well as training and continuing education of physicians. 28,41 Here, we report on the naloxone-related results of a national survey of physicians on IDU care.…”

Section: Introductionmentioning

confidence: 99%

Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

et al. 2006

View full text Add to dashboard Cite

Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a Btake-homed ose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.

show abstract

“…These problems may cause distress and trigger relapse even among persons who successfully reduce their substance use (Friedmann, Saitz, & Samet, 1998;McLellan & Weisner, 1996), and delivery of comprehensive services to address these issues has been shown to improve functioning, treatment retention, and outcomes (McLellan, Arndt, Metzger, Woody, & O'Brien, 1993;McLellan, Grisson, et al, 1993;McLellan & Weisner, 1996;McLellan et al, 1998). Despite their importance to quality substance abuse treatment (Leshner, 1999;Leukefeld, Pickens, & Schuster, 1992), the availability of comprehensive services declined from 1980to 1990(D'Aunno & Vaughn, 1995Etheridge, Craddock, Dunteman, & Hubbard, 1995;McLellan & Weisner, 1996;Widman, Platt, Lidz, Mathis, & Metzger, 1997). The current study examined whether the downward trend in the availability of comprehensive services in outpatient substance abuse treatment programs continued in the 1990s, while accounting for characteristics of these programs and their clientele.…”

Section: Introductionmentioning

confidence: 99%

Trends in comprehensive service availability in outpatient drug abuse treatment

Friedmann

Lemon

Durkin

et al. 2003

Journal of Substance Abuse Treatment

View full text Add to dashboard Cite

Comprehensive medical and psychosocial services are essential to quality addiction treatment, but their availability declined in the 1980s. To determine whether this downward trend in the availability of comprehensive services continued in the 1990s, we analyzed data from a national panel study of outpatient substance abuse treatment units in 1990, 1995, and 2000. Response rates were greater than 85%. Regarding the availability of comprehensive services, including physical examinations, routine medical care, mental health services, financial counseling and employment counseling, administrators reported whether any substance abuse treatment client received the service in the past year. With the exception of physical examinations, whose reported availability increased from 1990 to 1995, and financial counseling, whose reported availability decreased during the same time, the reported availability of comprehensive services changed little during the 1990s. These findings highlight the continuing need to monitor access to comprehensive services and other quality markers in addiction treatment over time.

show abstract

Science-Based Views of Drug Addiction and Its Treatment

Cited by 155 publications

References 14 publications

Choosing a behavioral therapy platform for pharmacotherapy of substance users

Choosing a behavioral therapy platform for pharmacotherapy of substance users

Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

Trends in comprehensive service availability in outpatient drug abuse treatment

Contact Info

Product

Resources

About