aimed at preventing relapse and reducing the severity of complications (McLellan et al., 2000). Underdosing of individuals with currently available medications has also been a problem (D’Aunno and Pollack, 2002).

These perceptions and attitudes are reflected in the separation between addiction treatment programs and regular medical care, a separation that perpetuates multiple barriers to the use of medication treatment for addictions. The clinical challenge of creating treatment programs tailored to the unique needs of the individual patient, as well as to the specific drugs to which he or she is addicted, is made more complicated by the existence of separate medical and addiction treatment systems. Moreover, the use of immunotherapies and sustained-release formulations will require complementary interventions with behavioral therapies, representing a major challenge to current practitioner and provider structures.

This chapter first reviews potential barriers to the integration of immunotherapies and sustained-release formulations in specialty addiction treatment programs and primary care medical settings. In the specialty setting, medical expertise and infrastructure must be developed or coordinated with behavioral interventions; in the primary care setting, behavioral interventions must be made available or developed for coordinated delivery with the medication treatments. The chapter then reviews the currently available medications for treating substance abuse disorders, identifying some lessons learned by the adoption of (or failure to adopt) these medications in substance abuse treatment. Lastly, we briefly consider some cost and related economic issues.

SPECIALTY ADDICTION TREATMENT SETTINGS

Current specialty addiction treatment programs do not routinely provide extensive medical services, and when medical services are provided, they are ancillary to the central role of psychosocial behavioral treatment (Substance Abuse and Mental Health Services Administration, 2002). The absence of medical services reflects organizational structures and staffing patterns in addiction treatment programs (D’Aunno, Vaughn, and McElroy, 1999; Nohria and Gulati, 1995), the philosophical resistance of staff to using medications for addictive disorders (Woody, 2003), and financing limitations that arise from the way that specialty addiction treatment is provided (Coffey et al., 2001; Mark et al., 2000).

Organization

Most specialty addiction care is provided in small, outpatient clinics that have little overlap with the larger general medical system, and they



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