Type of Drug Addicts to be treated
     From the point of view of treatment, the drug addicts in India can be divided  into three main groups:                   
There is a large group which uses opium or cannabisdrugs in small or very moderate quantities. The majority of these started the drug after middle age, generally for some minor disease or ailment. They usually started with a small dose and did not increase it. The narcotic and the euphoric effects of the drug have no attraction for them; indeed, these were not produced in this group at all. The habitu�s thus have not the temptation to increase the dose, in fact they fully appreciate the evil effects which could result from such an increase. Most of them are good and successful citizens, and carry on their daily work quite efficiently. The present writers have known numerous persons who have taken small doses of opium (half a grain or so) or cannabis drugs for twenty to thirty years without any apparent harm, and have lived to a ripe old age. The use of the drug was started during the middle period of life for some minor ailment such as cough, looseness of the bowels, mild joint pains, etc., and it was found that it afforded relief. It appeared to do no apparent harm and was therefore taken daily. As a matter of fact it appeared that the drug was actually doing them good, as its discontinuance made them ill and prevented them from carrying on their ordinary work. It stands to reason that, when a person can lead an active and useful life on fixed and unchanging doses, there could hardly be any mental or moral deterioration. Treatment in this group, which was not insignificant in the old days, would appear to be quite unnecessary. Some of this group, however, gradually increased their doses and suffered from the effects of the drug. In such cases only was treatment desirable or necessary.

        The next group - and a very large one - consisted of those who owed their entry into the paths of addiction entirely to association with and the example of other addicts. Some of these were normal individuals who were anxious to be treated, and they responded quite well to treatment. A proportion, however, started the habit from idle or deliberate seeking after new sensations. They took to the drug for its pleasure-giving effect and for sexual stimulation; these people were generally found in large towns. Many of them had some defect in their character and mental make-up, and appeared to be engrossed in furthering their indulgence and increasing the doses. They also had a tendency to indulge in more than one drug at the same time - e.g., alcohol and opium; alcohol and cocaine; alcohol, opium and cannabis drugs. This class of vicious addict was the most difficult from the point of view of treatment. Fortunately, this type, corresponding more to those met with in western countries, was not commonly met with in India. The few that existed belonged generally to the rich and indolent classes. They did not seek treatment, and nothing short of forced confinement in a special institution and prolonged training and reconstruction of character would restore them.

       There was the third smaller group of habitu�s who had started using the drug in an attempt to tide over a period of special strain, overwork and fatigue. This class of addict was the product of large towns, and their percentage was not nearly so high in India as in the west. This was the class anxious to get rid of the habit; they were easily amenable to treatment, and did very well even under non-institutional treatment.

Hospital Treatment            
        With admission to the hospital for withdrawal, the patient should undergo an evaluation, including urine drug screens, to determine whether he or she has been using other drugs not previously mentioned.[36] Detoxification is initiated to withdraw the patient from the substance of abuse and to restore cognitive ability. No other treatment goals should be addressed until both goals are achieved.
At that point, a major goal of therapy is to help the patient identify the consequences of his or her experiences and to understand the risks of relapse. Another goal is to address emotional issues such as hopelessness and despair over the seemingly inevitable progress of the addiction and grief and remorse associated with comprehension of past behavior. Barriers to recovery are identified, including internal barriers such as the patient's personality or personal resources and external barriers such as the home or work environment. The patient is protected from self-destructive or other violent behaviors.

Because dishonesty, violence and risk-taking are survival skills in active addiction but become self-destructive in recovery, new sets of behaviors are introduced. Twelve-step and other recovery programs describe a set of new behaviors that allow the addict to deal with the consequences of the past and the problems of the present. Involvement with groups such as Alcoholics, Narcotics or Cocaine Anonymous, Rational Recovery or Women for Sobriety should begin during hospitalization and be maintained after discharge; decreasing use of such support groups often leads to relapse.

Short-term hospitalization is useful as a means of facilitating entry into long-term treatment. By itself, however, hospitalization has no demonstrable effect on long-term recovery.

How effective is drug addiction treatment?

In addition to stopping drug use, the goal of treatment is to return the individual to productive functioning in the family, workplace, and community. Measures of effectiveness typically include levels of criminal behavior, family functioning, employability, and medical condition. Overall, treatment of addiction is as successful as treatment of other chronic diseases, such as diabetes, hypertension, and asthma.

Treatment of addiction is as successful as treatment of other chronic diseases such as diabetes, hypertension, and asthma.

According to several studies, drug treatment reduces drug use by 40 to 60 percent and significantly decreases criminal activity during and after treatment. For example, a study of therapeutic community treatment for drug offenders (See Treatment Section) demonstrated that arrests for violent and nonviolent criminal acts were reduced by 40 percent or more. Methadone treatment has been shown to decrease criminal behavior by as much as 50 percent. Research shows that drug addiction treatment reduces the risk of HIV infection and that interventions to prevent HIV are much less costly than treating HIV-related illnesses. Treatment can improve the prospects for employment, with gains of up to 40 percent after treatment.

Although these effectiveness rates hold in general, individual treatment outcomes depend on the extent and nature of the patient's presenting problems, the appropriateness of the treatment components and related services used to address those problems, and the degree of active engagement of the patient in the treatment process.

How long does drug addiction treatment usually last?

Individuals progress through drug addiction treatment at various speeds, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate lengths of treatment. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited or no effectiveness, and treatments lasting significantly longer often are indicated. For methadone maintenance, 12 months of treatment is the minimum, and some opiate-addicted individuals will continue to benefit from methadone maintenance treatment over a period of years.

Good outcomes are contingent on adequate lengths of treatment.

Many people who enter treatment drop out before receiving all the benefits that treatment can provide. Successful outcomes may require more than one treatment experience. Many addicted individuals have multiple episodes of treatment, often with a cumulative impact.

What helps people stay in treatment?

Since successful outcomes often depend upon retaining the person long enough to gain the full benefits of treatment, strategies for keeping an individual in the program 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 include motivation to change drug-using behavior, degree of support from family and friends, and whether there is pressure to stay in treatment from the criminal justice system, child protection services, employers, or the family. Within the program, successful counselors are able to establish a positive, therapeutic relationship with the patient. The counselor should ensure that a treatment plan is established and followed so that the individual knows what to expect during treatment. Medical, psychiatric, and social services should be available.

Whether a patient stays in treatment depends on factors associated with both the individual and the program.

Since some individual problems (such as serious mental illness, severe cocaine or crack use, and criminal involvement) increase the likelihood of a patient dropping out, intensive treatment with a range of components may be required to retain patients who have these problems. The provider then should ensure a transition to continuing care or "aftercare" following the patient's completion of formal treatment.

Is the use of medications like methadone simply replacing one drug addiction with another?

No. As used in maintenance treatment, methadone and LAAM are not heroin substitutes. They are safe and effective medications for opiate addiction that are administered by mouth in regular, fixed doses. Their pharmacological effects are markedly different from those of heroin.

As used in maintenance treatment, methadone and LAAM are not heroin substitutes.

Injected, snorted, or smoked heroin causes an almost immediate "rush" or brief period of euphoria that wears off very quickly, terminating in a "crash." The individual then experiences an intense craving to use more heroin to stop the crash and reinstate the euphoria. The cycle of euphoria, crash, and craving�repeated several times a day�leads to a cycle of addiction and behavioral disruption. These characteristics of heroin use result from the drug's rapid onset of action and its short duration of action in the brain. An individual who uses heroin multiple times per day subjects his or her brain and body to marked, rapid fluctuations as the opiate effects come and go. These fluctuations can disrupt a number of important bodily functions. Because heroin is illegal, addicted persons often become part of a volatile drug-using street culture characterized by hustling and crimes for profit.

Methadone and LAAM have far more gradual onsets of action than heroin, and as a result, patients stabilized on these medications do not experience any rush. In addition, both medications wear off much more slowly than heroin, so there is no sudden crash, and the brain and body are not exposed to the marked fluctuations seen with heroin use. Maintenance treatment with methadone or LAAM markedly reduces the desire for heroin. If an individual maintained on adequate, regular doses of methadone (once a day) or LAAM (several times per week) tries to take heroin, the euphoric effects of heroin will be significantly blocked. According to research, patients undergoing maintenance treatment do not suffer the medical abnormalities and behavioral destabilization that rapid fluctuations in drug levels cause in heroin addicts.