Research Issues in Treatment

The Focus of Treatment Research Characteristics of Research Participants

Initial diagnosis of substance dependence is most often observed in the third through fifth decades of life and is often preceded by the emergence of an array of consequences over time stemming from substance use that are representative of a less severe substance use disorder. Treatments can focus on those with different levels of severity of their substance use problem and those who use different classes of substances (e.g., opioids or alcohol). Thus, treatments can have different goals. For example, for some individuals on the less severe end of the spectrum of substance use problems, goals related to controlled use that do not target abstinence from all substances but instead focus on reducing problematic use may be appropriate. For others on the more severe end of the problem spectrum, abstinence is likely the most appropriate goal. In fact, it is common for treatment providers to regard the more severe diagnosis of substance dependence as a chronic disorder, lasting throughout the lifetimes of individuals who hold the diagnosis, making these individuals prone to periods of remission and relapse to the disorder. Therefore, it is common that individuals with substance dependence diagnoses undergo treatment more than once in their lifetimes.

Background characteristics such as substance of choice, polysubstance use, risk factors such as early age of onset and positive family history of substance abuse, and the existence of co-occurring mental disorders may also influence recommendations for treatment. These characteristics may also portend differential risk for abusive patterns of substance use throughout the life span in terms of clinical course of the disorder and make effective treatment more complicated.

Substance abuse affects males and females at nearly every point across development and across racial, ethnic, and socioeconomic strata, necessitating treatment strategies for adolescents, adults, and the elderly and for strategies that transcend or that are specifically adapted to cultural characteristics of the populations in need of services. Therefore, research should evaluate outcomes of substance abuse treatment for such subpopulations. Treatment research should also attend to individual factors mentioned above, such as substance use characteristics, consequences, and co-occurring psychiatric conditions in the design and evaluation of treatment programs.

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