Opioid addiction treatment modalities and some guidelines to their optimal use.

Opioid addiction treatment consists of a broad range of treatment modalities, with each playing a valuable role within the overall network of treatment alternatives. Therapeutic communities are often the treatment of choice for addicts who are under legal contingencies and amenable to a rigorous process of life-style change. Methadone maintenance offers the most widely available treatment and is a modality that is compatible with the needs of many injecting heroin users. Outpatient drug-free models offer structure and support to detoxified opioid addicts and nonaddicted opioid abusers. New pharmacotherapies, including clonidine, LAAM, naltrexone and buprenorphine, provide promise for addressing the needs of many opioid abusers who are not currently accessing the treatment system. Furthermore, the treatment system could be better utilized if treatment planning was based more on the needs of the addict than on the ideological bias of the clinician; training efforts could be useful in facilitating change in clinician attitudes.