A Comprehensive Approach:
Preventing Blood-Borne Infections Among Injection Drug Users

Chapter 3, Section 2: Key Strategies

SUBSTANCE ABUSE TREATMENT

Drug addiction is a chronic illness characterized by compulsive, uncontrollable drug craving, seeking, and use, even in the face of enormous negative consequences. Though nearly all addicts believe initially that they can stop on their own, most of their attempts fail to achieve long-term abstinence (NIDA, 1999). Substance abuse treatment provides the medical, psychological, and behavioral support necessary for individuals to stop using drugs and to allow their brain processes to return to pre-addiction functioning (see Negative Attitudes and Stigma Toward IDUs Persist Despite a New Understanding of Addiction for more detail on the changes in brain function that occur during addiction). Often, because of the complexity of the disease and the frequency of relapse to drug use, treatment requires multiple episodes over a long period of time.

For injection drug users, substance abuse treatment is a powerful disease prevention strategy. Drug injectors who do not enter treatment are up to six times more likely to become infected with HIV than are injectors who enter and remain in treatment (NIDA, 1999). Because substance abuse treatment helps users reduce or eliminate the number of drug injections, it lowers the risk of infection with HIV or hepatitis that might occur through unsafe injection practices, such as multi-person use of syringes or sharing of drug injection equipment (Thiede et al., 2000). It also prevents or reduces other harmful consequences of drug use, such as abscesses and endocarditis (inflammation of the lining of the heart). Further, because drug use impairs rational decision making, which can lead to high-risk behavior, substance abuse treatment can reduce the risk of HIV and hepatitis infection that can occur through high-risk, unprotected sex.

In the last decade, the effectiveness of substance abuse treatment and its broader social benefits have been emphatically demonstrated (Gerstein and Harwood, 1990; Hubbard et al., 1989; Metzger et al., 1998; NIDA, 1999; NIH, 1997a; Pickens et al., 1991). Successful treatment can have a major positive impact on many areas of a person's life, helping him or her improve family life, employment and health, and decrease involvement with crime. Overall, treatment for addiction is as successful as treatment of other chronic conditions, such as asthma, diabetes, and hypertension (NIDA, 1999; O'Brien and McLellan, 1996).

Substance abuse treatment makes financial sense as well. Every $1 invested in substance abuse treatment reduces the costs of drug-related crime, criminal justice costs, and theft by $4 to $7. The average cost of 1 year of methadone maintenance treatment is $4,700 per person. The cost of 1 year of imprisonment per person is about $18,400. When health care savings are added in, total savings can exceed costs by a ratio of 12 to 1 (NIDA, 1999).

Substance abuse treatment programs also reach drug users and their partners with other HIV prevention messages and interventions. Participation in these intervention offered in the treatment setting is associated with reduced drug- and sex-related risk behaviors (Calsyn et al., 1992; El-Bassel and Schilling, 1992; Malow et al., 1994; McCusker et al., 1993).

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