Overview: the treatment of drug dependence

Addictive disorders resemble other chronic medical disorders in that they are characterized by relapses and remissions. This central feature of the addictions is addressed by many of the contributors in their individual chapters. There are also several specific points raised in the chapters which merit further discussion. For instance, any assumption that long-term anti-anxiety treatment with benzodiazepines implies a form of dependence that requires treatment could be set against an alternative view that there may be appropriate medical/psychiatric indications for such prolonged treatment. There are also interesting questions which deserve discussion surrounding the debate over treatment setting for opiate dependence treatments. The paper by Johns presents a case for inpatient treatment whereas in the United States long-term methadone maintenance is seen as one of the most effective treatments. Given the complexity of the bio-psycho-social mechanisms involved in addiction, a combination of therapeutic approaches tailored to individual needs should probably continue to be the guiding principle.