Discussion Topics

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Addiction is a multidimensional construct comprising patient-specific biopsychosocial and spiritual factors. As such, no single treatment approach is able to address the complex signs and symptoms of this chronic, progressive disease. Instead, a combination of psychosocial strategies and pharmacologic treatments is commonly used to address each patient's unique constellation of symptoms and medical, psychosocial, vocational, and legal needs.

The principal efficacy measure for any substance abuse treatment program is reduction in or abstinence from drug use. Monitoring drug use, therefore, is an essential component of all treatment strategies, helping clinicians assess outcomes, identify relapses, and adjust therapies as needed. Frequent unscheduled (random) drug testing encourages treatment adherence, which, in turn, improves outcomes. In a new paradigm, the authors proposed that treatment for substance use disorders should endure for years, even after remission is achieved, and include careful monitoring of all alcohol and drug use with prompt, meaningful consequences for patients who relapse.

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