Drug abuse cessation programmes
and relapse prevention
While considered cost-effective (Fountain 1995; Hubbard 1995; Hubbard et al. 1997; NIDA 1999b), treatment paradigms for the cessation of drug abuse and maintenance of habit change generally are successful for only a minority of persons who go through them (Powell et al. 1993). This current status of treatment may be due in part to the fact that although the physical components of an addiction are easily disrupted (for example withdrawal), other factors contributing to the maintenance of drug use behaviour continue to challenge practitioners and researchers. Programme attrition continues to present serious challenges to treatment effectiveness (Leshner 1997). In addition, relapse rates continue to be very high (Carroll 1989; Marlatt 1990; Sussman et al. 1996c). Given a first cessation attempt after treatment, approximately 80 per cent of individuals relapse. Considering multiple attempts to quit using (relevant to tobacco, alcohol, heroin and marijuana use), up to only 40 per cent are abstinent or non-problematic users after ten years (Littrell 1991). Pharmacological efforts have been undertaken as a harm reduction strategy among those who seem unable to quit drug use. For example, methadone maintenance appears to benefit approximately 50 per cent of heroin addicts (Bell et al. 1999). However, these treatments do not provide a solution for maintenance of habit change. Available treatments certainly save the lives of some drug abusers, but not most of them.
It also appears that most treatment for drug abuse around the world is provided to males (65–99 per cent: 65 per cent in Central America; 76 per cent in western Europe; 90 per cent in Mexico; 96 per cent in East Asia; 99 per cent in South Asia: US DHHS 1998). Also, a majority of persons treated for drug abuse fall into an age range of 20–34 years old (15–24 years old may be a more accurate range in Mexico). Thus, available treatments tend to focus on young males. These same treatments are not often used with younger or older persons or with females. Thus, it is difficult to ascertain the overall success of treatment programmes. Maybe these current treatments are in need of revision to be more applicable for young males; we are not sure what works for others.