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Methadone has been used successfully as a substitution agent for heroin dependency for more than 30 years. As a result of its success, other effective methods of treatment have been neglected. Established as a key text on all treatment options for drug misusers, Community Treatment of Drug Misuse: More Than Methadone has been highly praised for its practical orientation based on a solid research background. For the second edition, all the main evidence-based and more pragmatic treatment approaches are reviewed, not only in the management of opiate dependence, but across the range of drugs. It focuses extensively on developments in the last few years as a result of policy initiatives and research findings, including coverage of buprenorphine treatment, the systematic treatment of cocaine abuse and work with special patient groups. This is of direct relevance to medical as well as non-medical practitioners undertaking clinical work in the addictions.
Opiate addiction is one misuse and dependence disorder for which we have good pharmacological treatments. Both methadone and buprenorphine are effective in withdrawing individuals from opiates via substitution, and their use in maintenance treatment has an excellent track record. Naltrexone may also be efficacious for selected patients. Psychosocial and behavioral treatments play a role too, most often in combination with pharmacological treatments or for patients who do not want pharmacological treatments. This is one subject in which practice varies enormously in different parts of the world. Readers who look at the text closely will notice considerable geographical variation in treatment polices, and it is a tribute to our authors that they have kept this to a minimum in this combined chapter.
Opioid dependence is a chronic disorder characterized by relapse, increased mortality, significant medical morbidity, psychiatric sequelae and impaired social function in the individual. Accompanying these detrimental effects to the dependent individual are costs to their families and society secondary to impaired social and occupational functioning and increased criminal behavior or violence. In recent years there have been considerable gains in our understanding of the neurobiology of opioid dependence and in the development of new pharmacological and behavioral treatments for opioid dependence.
In 1999 there were estimated to be 1 million chronic users of heroin in the United States, or 0.4% (4 per 1000) of the population (Rhodes et al., 2000).