In addition to stopping drug abuse, treating drug addicts aims to return the user to productive life by functioning in the family, workplace and community. Some research that followed individuals in treatment over extended periods showed that most people who get into and remain in treatment stop using drugs, exhibit a decrease in criminal activity and improve occupational, social and psychological functioning. For example, studies show that methadone treatment increases participation in behavioral therapy and decreases both drug use and criminal behavior. However, individual treatment outcomes depend on the extent and nature of the problems of the patient, the appropriateness of treatment and related services doctors use to address those problems and the quality of interaction between the patient and the treatment providers. Relapse rates for addiction resemble those of other chronic conditions like diabetes, hypertension and asthma. Like other chronic conditions, drug addicts can learn to manage the issue successfully. Treatment enables a person to counteract the powerful disruptive effects that addiction has on brain and behavior in order to regain control. The chronic nature of addiction means that relapsing and using drugs is not only possible, but also likely. The rates of drug relapse are similar to those of other chronic medical illnesses such as diabetes, hypertension and asthma. Unfortunately, when relapse occurs many people consider treatment a failure. However, successful treatment for addiction often requires continual evaluation and modification as appropriate. For example, when a patient receives active treatment for hypertension and symptoms decrease, doctors consider the treatment successful, even though symptoms may reappear when the patient stops treatment. For the addicted patient, lapses to drug abuse do not indicate failure, but rather signify that doctors need to reinstate, adjust or alter treatment.

Drug Abuse and Mental Disorders

Mounting evidence suggests that common genetic factors may predispose individuals to both mental disorders and addiction, or to having a greater risk of the second disorder, once the first appears. Stress, trauma like physical or sexual abuse and early exposure to drugs are common factors that can lead to addiction and to mental illness, particularly in those with underlying genetic vulnerabilities. Both drug and mental disorders affect some of the same areas of the brain. For example, the areas of the brain that react to drug use are the same as those circuits that react to reward processing and show abnormalities in specific mental disorders. Drug abuse and mental illness are developmental disorders. Drug abuse and mental illness often begin in adolescence or even childhood, which are periods when the brain undergoes dramatic developmental changes. Early exposure to drugs can change the brain in ways that increase the risk for mental illness, just as early symptoms of a mental disorder may increase vulnerability to drug abuse.

Co-Occurring Drug Abuse and Mental Health

Offenders with co-occurring drug abuse and mental health problems often require an integrated treatment approach. High rates of mental health problems are present in offender populations and in those with substance abuse problems. Drug abuse treatment can sometimes address depression, anxiety and other mental health problems. Personality, cognitive and other serious mental disorders can be difficult to treat and may disrupt drug treatment. The presence of co-occurring disorders may require an integrated approach that combines drug abuse treatment with psychiatric treatment, including the use of medication. A physician should assess Individuals with either a substance abuse or mental health problem for the presence of the other.

Medications for Drug Abuse

Medications are important parts of treatment for many drug abusing offenders. For heroin addiction, medicines such as methadone and buprenorphine help normalize brain function and individuals who may benefit from them should take them. Effective use of medications can be instrumental in enabling people with co-occurring mental health problems to function successfully in society. Behavioral strategies can increase adherence to medication regimens.

Chronic Conditions Prevention

Treatment planning for drug abusing offenders who are living in or returning the community should include strategies to prevent and treat serious, chronic medical conditions, such as HIV/AIDS, hepatitis B and C and tuberculosis.
The rates of infectious diseases, such as hepatitis, tuberculosis and HIV/AIDS, are higher in drug abusers, incarcerated offenders and offenders under community supervision than in the general population. Infectious diseases affect not just the offender, but also the criminal justice system and the wider community. Consistent with federal and state laws, offenders who have abused drugs should be tested for infectious diseases and receive counseling on health practices and on ways to modify risky behaviors. Probation and parole officers who monitor offenders with serious medical conditions should link them with appropriate healthcare services, encourage compliance with medical treatment and re-establish eligibility of the offender for public health services like Medicaid.