Update on alcohol and drug disorder treatment.

The numbers of patients in all forms of psychoactive substance abuse disorder treatments have dramatically risen in the past decade, and it is estimated that $1.8 billion are spent on alcohol and drug inpatient and outpatient treatment. Recent developments in therapeutic modalities and the differential therapeutics of alcohol and psychoactive drug abuse treatment are presented. Choice of treatment setting, combination of treatment modalities, and the special needs of subpopulations are discussed in terms of both review of the literature and practical decisions made by clinicians. Problems in diagnosis and treatment and the dual-diagnosis patient, patients with multiple substance abuse, women, minorities, and the homeless are touched upon. The heterogeneous nature of patients with psychoactive substance abuse problems requires flexibility and sophistication in treatment design, with attention to biopsychosocial variables. The treatment implications of recent developments in diagnosis such as DSM-III-R, research on AIDS in relation to substance abuse, and studies of familial alcoholism and fetal alcoholism are highlighted. A concise update of detoxification, pharmacotherapy, behavioral treatment, psychodynamically informed approaches, family therapy, and group therapy focuses on clinical decisions. Although demonstrating overall efficacy of alcohol treatment, few studies demonstrate differential responses for subpopulations or specific treatment modalities.