To outsiders who are not involved in drug treatment, it would seem that abstinence would be the measure of a successful rehabilitation. Complete abstinence, however, cannot be measured, because after the patients leave care, their actions cannot be recorded. The National Institute on Drug Abuse (2002) states that effective treatment is reached when an individual is capable of being a productive citizen and family member. This is measured through the levels of criminal behavior, employability, medical condition, and family functioning (p. 15). Many studies, however, are restricted to the length of stay in treatment to evaluate the success of the program.
According to Heinrich and Lynn (2002), drug treatment exists in two major forms in America: residential and outpatient. Within these groups, there are important differences. Residential treatment is divided into to categories: long-term and short-term. Outpatient treatment includes drug-free and drug substitute programs.
Long-term residential treatment is considered anything over six months in a rehabilitation facility. For the first thirty days, patients are immersed in the treatment program. Along with daily lectures and presentations, there are daily group therapy sessions and individual counseling (McMillan, p.51) Around the clock care is given in an attempt to resocialize the patient (NIODA, 2002 p.28). The treatment puts emphasis on being personally accountable and responsible.
McCusker et al. (2001) studied the efficacy of residential programs in two treatment facilities. Success was based on retention in treatment and follow-up interviews. The study included 628 clients and compared results for those enrolled in six and a twelve month programs. The long stay subjects seemed to benefit from lengthier treatment, at least in terms of delaying time to first drug use. They also experienced fewer drug, alcohol, legal, and employment problems as evidenced by follow-up interviews. This study reinforces the belief that longer treatment has more significant results than the shorter programs.
The least expensive and most popular in America today are the outpatient programs. Drug substitutes are used often times in these treatments. The two drugs that are utilized to wean opiate (especially heroin) users off of their dependancy are methadone and LAAM (Levo-alpha-acetylmethadol) (Bellenir 1996) .
Methadone was developed in 1965 to replace the often dangerous act of injecting heroin. This treatment can be used for anywhere from 6 months to many years. McLellan et al. (1993) studied three groups of patients receiving the same dose of methadone. The first group received only the methadone treatment. The second group received weekly counseling in addition to methadone. The third group received the methadone, counseling, and on-site medical care. Results indicated that 69% of the methadone only group continued substance abuse. The group who also received counseling showed a 50% reduction in drug use. The third group, which received additional medical care, showed the most improvement at 81% reduction (p.1958).
